Provider Demographics
NPI:1295788628
Name:FERGUSON, STEVEN W (MD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:W
Last Name:FERGUSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 COMMERCE STREET
Mailing Address - Street 2:
Mailing Address - City:POWELLSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27967-0040
Mailing Address - Country:US
Mailing Address - Phone:252-332-6484
Mailing Address - Fax:252-332-1660
Practice Address - Street 1:105 COMMERCE STREET
Practice Address - Street 2:
Practice Address - City:POWELLSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27967-0040
Practice Address - Country:US
Practice Address - Phone:252-332-6484
Practice Address - Fax:252-332-1660
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC36700207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8931664Medicaid
E99352Medicare UPIN
NC080177209Medicare PIN
NC2186425DMedicare PIN