Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 247146 | MA |
Y | 208000000X | Pediatrician | MD20538 | ME |
N | 2080P0203X | Pediatric Critical Care Doctor | MT202833 | PA |
NPI | 1013181668 |
---|---|
Provider Name | Michael Alexander Ferguson |
First Address | Portland, ME 04103-1073 |
Second Address | Portland, ME 04102-3134 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/04/2008 |
Last Update Date | 27/04/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1013181668 | (05) | ME |