Provider Demographics
NPI:1720068422
Name:FERGUSON, EUGENE J (MD)
Entity Type:Individual
Prefix:
First Name:EUGENE
Middle Name:J
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 1:150 E PENNSYLVANIA AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:DOWNINGTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19335-2602
Mailing Address - Country:US
Mailing Address - Phone:610-280-7960
Mailing Address - Fax:610-280-7962
Practice Address - Street 1:150 E PENNSYLVANIA AVE STE 200
Practice Address - Street 2:
Practice Address - City:DOWNINGTOWN
Practice Address - State:PA
Practice Address - Zip Code:19335
Practice Address - Country:US
Practice Address - Phone:610-280-7960
Practice Address - Fax:610-280-7962
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD453556207R00000X
ME016549207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME010211494Medicaid
PA383957LL4OtherMEDICARE
MEI09941Medicare UPIN