Provider Demographics
NPI:1114119708
Name:FERGUSON, SHERRY A
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:A
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 LOCUST TER
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-5307
Mailing Address - Country:US
Mailing Address - Phone:301-518-8516
Mailing Address - Fax:
Practice Address - Street 1:9730 HEALTHWAY DRIVE
Practice Address - Street 2:BERLIN HEALTH CENTER
Practice Address - City:BERLIN
Practice Address - State:MD
Practice Address - Zip Code:21811
Practice Address - Country:US
Practice Address - Phone:410-629-0164
Practice Address - Fax:410-629-0185
Is Sole Proprietor?:No
Enumeration Date:2007-08-16
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDS013Medicare UPIN