Provider Demographics
NPI:1396730396
Name:FERZOCO, VICTOR A (MD)
Entity type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:A
Last Name:FERZOCO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:111 CYPRESS ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-6002
Mailing Address - Country:US
Mailing Address - Phone:857-307-0896
Mailing Address - Fax:
Practice Address - Street 1:1337 HYDE PARK AVE
Practice Address - Street 2:C/O HYDE PARK MEDICAL CARE
Practice Address - City:HYDE PARK
Practice Address - State:MA
Practice Address - Zip Code:02136-2713
Practice Address - Country:US
Practice Address - Phone:617-364-9880
Practice Address - Fax:617-361-3663
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2012-07-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA78147207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
68634OtherHARVARD PILGRIM HEALTHCAR
MA772067OtherTUFTS
0401505OtherUNITED HEALTHCARE
110151320OtherPALMETTO GBA RAILROAD MED
813110OtherAETNA US HEALTHCARE
043235613OtherTAX ID GROUP BILLING NUMB
MA3169758Medicaid
0011043OtherNEIGHBORHOOD HEALTH PLAN
MAFEJ17846OtherBXBS
813110OtherAETNA US HEALTHCARE
MA772067OtherTUFTS