Provider Demographics
NPI:1053310607
Name:FERGUSON, CLIFFORD LESTER (MD)
Entity Type:Individual
Prefix:DR
First Name:CLIFFORD
Middle Name:LESTER
Last Name:FERGUSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9813 HILL ST
Mailing Address - Street 2:
Mailing Address - City:KENSINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20895-3136
Mailing Address - Country:US
Mailing Address - Phone:301-565-0670
Mailing Address - Fax:202-806-4453
Practice Address - Street 1:9813 HILL ST
Practice Address - Street 2:
Practice Address - City:KENSINGTON
Practice Address - State:MD
Practice Address - Zip Code:20895-3136
Practice Address - Country:US
Practice Address - Phone:301-565-0670
Practice Address - Fax:202-806-4453
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-16
Last Update Date:2017-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD23677207R00000X
DCMD22137207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCG90195Medicare UPIN