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NPI Code Detail

MEDICARE: MAREIKE I FERGUSON PA

MEDICARE: MAREIKE I FERGUSON PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant50.004810RXOH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1861940660
Entity Type Code : Individual
Provider Name (Legal Business Name) : MAREIKE I FERGUSON PA
Provider Business Mailing Address
First Line : 6680 POE AVE STE 200
Second Line :
City : DAYTON
State : OH
Zip : 45414-2855
Country : US
Telephone Number : 937-280-8400
Fax Number : 937-280-8373
Provider Business Practice Location Address
First Line : 2350 MIAMI VALLEY DR STE 500
Second Line :
City : CENTERVILLE
State : OH
Zip : 45459-4780
Country : US
Telephone Number : 937-293-1622
Fax Number : 937-245-6308
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/21/2016
Last Update Date : 12/16/2025

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Directions to “ MAREIKE I FERGUSON PA” Practice Location

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