Individual
MARK G. FERRARA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1000 MEDICAL CENTER BLVD, LAWRENCEVILLE, GA 30046-7694
(678) 312-4440
Mailing address
PO BOX 1746, INDIANAPOLIS, IN 46206-1746
(877) 383-4442
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
01063961A
IN
2085R0202X
Diagnostic Radiology Physician
Primary
063191
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200905210
—
IN
05
—
899100669
—
GA
01
—
P00629941
RAILROAD MEDICARE
IN
01
—
P00963909
RR MEDICARE
GA
Enumeration date
06/10/2008
Last updated
04/06/2022
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