Provider Demographics
NPI:1689664575
Name:FERGUSON, JANALYN P (MD)
Entity Type:Individual
Prefix:DR
First Name:JANALYN
Middle Name:P
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5901 TECHNOLOGY CENTER DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46278-6013
Mailing Address - Country:US
Mailing Address - Phone:317-328-5050
Mailing Address - Fax:317-328-5053
Practice Address - Street 1:5901 TECHNOLOGY CENTER DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46278-6013
Practice Address - Country:US
Practice Address - Phone:317-328-5050
Practice Address - Fax:317-715-9965
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01040352A2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000492344OtherANTHEM 203778927
IN100369270Medicaid
INQ0072105OtherCMOSHO351158723&352047427
IN000000082135OtherANTHEM-351158723
IN002118OtherSIHO-351158723
IN052078OtherHEALTH ALLIANCE-351158723
IN300101570OtherRR MEDICARE-351158723
IN052078OtherHEALTH ALLIANCE-351158723
INQ0072105OtherCMOSHO351158723&352047427