Provider Demographics
NPI:1093058646
Name:FERGUSON, GRACE PANG-FRIED (MD)
Entity Type:Individual
Prefix:DR
First Name:GRACE
Middle Name:PANG-FRIED
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1307 FEDERAL ST STE B201
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15212-4774
Mailing Address - Country:US
Mailing Address - Phone:412-359-3355
Mailing Address - Fax:412-359-6216
Practice Address - Street 1:1307 FEDERAL ST STE B201
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15212-4774
Practice Address - Country:US
Practice Address - Phone:412-359-3355
Practice Address - Fax:412-359-6216
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-02
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD455146207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103285023Medicaid