Provider Demographics
NPI:1194795781
Name:FERRANTE, MARYBETH (MD)
Entity type:Individual
Prefix:DR
First Name:MARYBETH
Middle Name:
Last Name:FERRANTE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:625 MOUNT AUBURN ST
Mailing Address - Street 2:STE 104
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-4555
Mailing Address - Country:US
Mailing Address - Phone:617-491-5586
Mailing Address - Fax:617-661-5995
Practice Address - Street 1:625 MOUNT AUBURN ST
Practice Address - Street 2:STE 104
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-4555
Practice Address - Country:US
Practice Address - Phone:617-491-5586
Practice Address - Fax:617-661-5995
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA80493207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3180395Medicaid
MAG13197Medicare UPIN
MAA20473Medicare PIN