Provider Demographics
NPI:1811986441
Name:FERGUSON, JOSEPH M (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:M
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 1:2500 CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-3312
Mailing Address - Country:US
Mailing Address - Phone:540-374-8140
Mailing Address - Fax:540-374-8190
Practice Address - Street 1:2500 CHARLES ST
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-3312
Practice Address - Country:US
Practice Address - Phone:540-374-8140
Practice Address - Fax:540-374-8190
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101055279207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G62839Medicare UPIN
VA00W034J01Medicare PIN