Provider Demographics
NPI:1073571667
Name:FERGUSON, DALE (MD)
Entity Type:Individual
Prefix:
First Name:DALE
Middle Name:
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 1:21 WHITEHALL RD STE 205
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03867-3236
Mailing Address - Country:US
Mailing Address - Phone:603-994-5111
Mailing Address - Fax:603-994-0025
Practice Address - Street 1:21 WHITEHALL RD STE 205
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03867-3236
Practice Address - Country:US
Practice Address - Phone:603-994-5111
Practice Address - Fax:603-994-0025
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2009-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH7711207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30217273Medicaid
NH30217273Medicaid
NHRE0478Medicare ID - Type Unspecified