Provider Demographics
NPI:1467207761
Name:FERGUSON, EMILY BLAIR (RT (R))
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:BLAIR
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:RT (R)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7119 WHITE MARSH RD
Mailing Address - Street 2:
Mailing Address - City:ELBERON
Mailing Address - State:VA
Mailing Address - Zip Code:23846-2512
Mailing Address - Country:US
Mailing Address - Phone:757-344-7667
Mailing Address - Fax:
Practice Address - Street 1:325 CHARLES H DIMMOCK PKWY STE 100
Practice Address - Street 2:
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834-2986
Practice Address - Country:US
Practice Address - Phone:804-524-4077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-19
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2471C3402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiography