Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 054028 | CT |
Y | 2080P0216X | Pediatric Rheumatologist | 054028 | CT |
NPI | 1831327436 |
---|---|
Provider Name | Dr. Ian David Ferguson |
First Address | New Haven, CT 06519-1304 |
Second Address | New Haven, CT 06519-1304 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2009 |
Last Update Date | 08/12/2015 |