Provider Demographics
NPI:1447208392
Name:FERGUSON, MARTHA A (MD)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:A
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 1:3200 BURNET AVE
Mailing Address - Street 2:3 SOUTH, CREDENTIALING
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-3019
Mailing Address - Country:US
Mailing Address - Phone:513-475-8787
Mailing Address - Fax:513-929-4369
Practice Address - Street 1:2123 AUBURN AVE.
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219
Practice Address - Country:US
Practice Address - Phone:513-475-8787
Practice Address - Fax:513-929-4369
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA050579208C00000X
OH35068079208C00000X
OH35.068079208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
1400016OtherUNITED HEALTHCARE
2668428OtherAETNA HMO
7494880OtherCIGNA HMO
KY7100083470Medicaid
IN200960570Medicaid
OH2125926Medicaid
GA00928848AMedicaid
52821623OtherBCBS
1288OtherKAISER
5106771OtherAETNA NON HMO
KY7100083470Medicaid
1400016OtherUNITED HEALTHCARE
52821623OtherBCBS
G95766Medicare UPIN
OH0879362Medicare PIN