Provider Demographics
NPI:1326010919
Name:FERGUSON, JENNIFER (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
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 1:7001 FOREST AVE
Mailing Address - Street 2:302
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-1726
Mailing Address - Country:US
Mailing Address - Phone:804-282-2655
Mailing Address - Fax:804-672-4948
Practice Address - Street 1:7001 FOREST AVE
Practice Address - Street 2:302
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-1726
Practice Address - Country:US
Practice Address - Phone:804-282-2655
Practice Address - Fax:804-672-4948
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2011-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101046035207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA137083OtherBCBS
VAP00100173OtherRAILROAD MEDICARE
VA010047927Medicaid
VA010236797Medicaid
VA188196OtherBLUE CROSS BLUE SHIELD
VA00W950P02Medicare PIN
VA004979P92Medicare PIN
VAP00100173OtherRAILROAD MEDICARE