Provider Demographics
NPI:1659395390
Name:FERGUSON, AMY E (MD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:E
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:71 ALLEN ST
Mailing Address - Street 2:STE 403
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-4570
Mailing Address - Country:US
Mailing Address - Phone:802-772-4414
Mailing Address - Fax:802-772-7973
Practice Address - Street 1:1 GENERAL WING RD
Practice Address - Street 2:CHCRR PEDIATRICS
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-4681
Practice Address - Country:US
Practice Address - Phone:802-773-9131
Practice Address - Fax:802-773-1551
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2016-08-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VT042-0009717208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30200039Medicaid
NY04312281Medicaid
VT1006417Medicaid
NY04312281Medicaid