Provider Demographics
NPI:1508956814
Name:FERGUSON, KATHERINE ANTONIA (MD)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ANTONIA
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 1:2705 BARONHURST DR
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22181-6158
Mailing Address - Country:US
Mailing Address - Phone:703-938-1339
Mailing Address - Fax:
Practice Address - Street 1:380 MAPLE AVE W
Practice Address - Street 2:SUITE 205
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-5620
Practice Address - Country:US
Practice Address - Phone:703-255-3220
Practice Address - Fax:703-938-2440
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-15
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010419982084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA470916Medicare ID - Type Unspecified
VAC89219Medicare UPIN