Provider Demographics
NPI:1972562007
Name:FERRETTA, MICHAEL DAVID JR
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DAVID
Last Name:FERRETTA
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:USS GONZALEZ DDG 66
Mailing Address - Street 2:MEDICAL DEPARTMENT
Mailing Address - City:FPO
Mailing Address - State:AE
Mailing Address - Zip Code:09570-1284
Mailing Address - Country:US
Mailing Address - Phone:757-445-6269
Mailing Address - Fax:
Practice Address - Street 1:USS GONZALEZ DDG 66
Practice Address - Street 2:MEDICAL DEPARTMENT
Practice Address - City:FPO
Practice Address - State:AE
Practice Address - Zip Code:09570-1284
Practice Address - Country:US
Practice Address - Phone:757-445-6269
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-18
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman