Provider Demographics
NPI:1447211800
Name:FERGUSON, MARY SARAH (MD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:SARAH
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2881 CAPE GEORGE RD
Mailing Address - Street 2:
Mailing Address - City:PORT TOWNSEND
Mailing Address - State:WA
Mailing Address - Zip Code:98368-9451
Mailing Address - Country:US
Mailing Address - Phone:510-882-6107
Mailing Address - Fax:925-307-5742
Practice Address - Street 1:2881 CAPE GEORGE RD
Practice Address - Street 2:
Practice Address - City:PORT TOWNSEND
Practice Address - State:WA
Practice Address - Zip Code:98368
Practice Address - Country:US
Practice Address - Phone:510-882-6107
Practice Address - Fax:925-307-5742
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-28
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG43565207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE85480Medicare UPIN
CA00G435650Medicare PIN