Healthcare Provider Details

I. General information

NPI: 1447208392
Provider Name (Legal Business Name): MARTHA A FERGUSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 07/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2123 AUBURN AVE.
CINCINNATI OH
45219
US

IV. Provider business mailing address

3200 BURNET AVE 3 SOUTH, CREDENTIALING
CINCINNATI OH
45229-3019
US

V. Phone/Fax

Practice location:
  • Phone: 513-475-8787
  • Fax: 513-929-4369
Mailing address:
  • Phone: 513-475-8787
  • Fax: 513-929-4369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number050579
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number35068079
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number35.068079
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: