Provider Demographics
NPI:1780688416
Name:MICHAEL, DAVID FERGUSON (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:FERGUSON
Last Name:MICHAEL
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 1:2610 STANTONSBURG RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-2800
Mailing Address - Country:US
Mailing Address - Phone:252-847-9908
Mailing Address - Fax:
Practice Address - Street 1:2610 STANTONSBURG RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-2800
Practice Address - Country:US
Practice Address - Phone:252-847-9908
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9600270207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8910377Medicaid
NC8910377Medicaid
NCG50990Medicare UPIN