Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 223898 | MA |
Y | 2080P0210X | Pediatric Nephrologist | 223898 | MA |
NPI | 1699712646 |
---|---|
Provider Name | Michael A Ferguson |
First Address | Boston, MA 02115-5724 |
Second Address | Boston, MA 02115-5724 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2006 |
Last Update Date | 09/12/2015 |