Provider Demographics
NPI:1770563561
Name:FERGUS, ALLAN H (MD)
Entity type:Individual
Prefix:
First Name:ALLAN
Middle Name:H
Last Name:FERGUS
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 1:1818 AMHERST ST
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-2869
Mailing Address - Country:US
Mailing Address - Phone:540-450-0072
Mailing Address - Fax:540-450-0074
Practice Address - Street 1:1818 AMHERST ST
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-2869
Practice Address - Country:US
Practice Address - Phone:540-450-0072
Practice Address - Fax:540-450-0074
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101232364207T00000X
WV29836207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP00657220OtherMEDICARE RR
WV2003298000Medicaid
VA1770563561Medicaid
VAH64958Medicare UPIN
WV2003298000Medicaid