Provider Demographics
NPI:1619547908
Name:FERGUSON, BELINDA DARLENE
Entity Type:Individual
Prefix:MS
First Name:BELINDA
Middle Name:DARLENE
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 1:9519 DAMASCUS DR
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20109-3329
Mailing Address - Country:US
Mailing Address - Phone:571-432-8686
Mailing Address - Fax:
Practice Address - Street 1:9519 DAMASCUS DR
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109-3329
Practice Address - Country:US
Practice Address - Phone:571-432-8686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-29
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA25731335202K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes202K00000XAllopathic & Osteopathic PhysiciansPhlebologyGroup - Single Specialty