Healthcare Provider Details

I. General information

NPI: 1861705857
Provider Name (Legal Business Name): FERGUSON CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2010
Last Update Date: 02/11/2020
Certification Date: 02/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1860 REISTERSTOWN RD
PIKESVILLE MD
21208-1335
US

IV. Provider business mailing address

4111 LOWER BECKLEYSVILLE RD STE C
HAMPSTEAD MD
21074-2248
US

V. Phone/Fax

Practice location:
  • Phone: 410-484-4044
  • Fax: 410-741-3797
Mailing address:
  • Phone: 410-374-0808
  • Fax: 410-741-3797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. LYNN MICHELLE GONDECK
Title or Position: MEDICAL ADMINISTRATOR
Credential:
Phone: 443-244-0318