Healthcare Provider Details

I. General information

NPI: 1780650853
Provider Name (Legal Business Name): STEVEN W FERGUSON DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 10/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 STATE STREET HAMOT FACULTY SPECIALISTS
ERIE PA
16550-0002
US

IV. Provider business mailing address

717 STATE STREET SUITE 16 LL, REGIONAL HEALTH SERVICES INC
ERIE PA
16501-1360
US

V. Phone/Fax

Practice location:
  • Phone: 814-877-4922
  • Fax: 814-877-3622
Mailing address:
  • Phone: 814-877-7100
  • Fax: 814-480-7604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOS007021L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: