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General NPI Number Information
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NPI Number | 1508956814
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Entity Type | Individual
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Provider Name | KATHERINE ANTONIA FERGUSON M.D.
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Gender | Female
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Dates
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Enumeration Date | 10/15/2006
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Last Update Date | 04/05/2012
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Provider Practice Location Address
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Address Line | 380 MAPLE AVE W SUITE 205
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City | VIENNA
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State | VA
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Zip | 22180-5620
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Country | US
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Telephone | 703-255-3220
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Fax | 703-938-2440
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Provider Business Mailing Address
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Address Line | 2705 BARONHURST DR
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City | VIENNA
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State | VA
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Zip | 22181-6158
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Country | US
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Telephone | 703-938-1339
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 0101041998
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License Number State | VA
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