Healthcare Provider Details

I. General information

NPI: 1720068422
Provider Name (Legal Business Name): EUGENE J FERGUSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 12/11/2019
Certification Date: 12/11/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 E PENNSYLVANIA AVE STE 200
DOWNINGTOWN PA
19335
US

IV. Provider business mailing address

150 E PENNSYLVANIA AVE STE 200
DOWNINGTOWN PA
19335-2602
US

V. Phone/Fax

Practice location:
  • Phone: 610-280-7960
  • Fax: 610-280-7962
Mailing address:
  • Phone: 610-280-7960
  • Fax: 610-280-7962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD453556
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: