Provider Demographics
NPI:1720003700
Name:DANIEL FERGUSON, M.D.
Entity Type:Organization
Organization Name:DANIEL FERGUSON, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:FERGUSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-794-4009
Mailing Address - Street 1:621 KELLY BLVD
Mailing Address - Street 2:
Mailing Address - City:SLIPPERY ROCK
Mailing Address - State:PA
Mailing Address - Zip Code:16057-8523
Mailing Address - Country:US
Mailing Address - Phone:724-794-4009
Mailing Address - Fax:724-794-4099
Practice Address - Street 1:621 KELLY BLVD
Practice Address - Street 2:
Practice Address - City:SLIPPERY ROCK
Practice Address - State:PA
Practice Address - Zip Code:16057-8523
Practice Address - Country:US
Practice Address - Phone:724-794-4009
Practice Address - Fax:724-794-4099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD040440L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012360630003Medicaid
PA176783OtherBLUE CROSS/BLUE SHIELD
PA216810OtherUPMC INSURANCE
PA216810OtherUPMC INSURANCE