Provider Demographics
NPI:1699906818
Name:FERRO, NICHOLAS PATRICK (DPM)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:PATRICK
Last Name:FERRO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4612 OUTER LOOP
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40219-3971
Mailing Address - Country:US
Mailing Address - Phone:502-804-4811
Mailing Address - Fax:
Practice Address - Street 1:2818 GRANT LINE RD
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-2492
Practice Address - Country:US
Practice Address - Phone:812-725-7542
Practice Address - Fax:812-725-7543
Is Sole Proprietor?:No
Enumeration Date:2009-08-05
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07001130A213E00000X, 213ES0103X
KY244145213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100205380Medicaid
IN201071090Medicaid
KY50041802OtherPASSPORT HEALTH PLAN
IN000000773843OtherANTHEM
INP01074651Medicare PIN
IN000000773843OtherANTHEM
KY50041802OtherPASSPORT HEALTH PLAN