1104096015 NPI number — ANGIER PEDIATRICS AND ADULT MEDICAL CENTER, PLLC

Table of content: DR. DENISE LOUISE FERGUSON PSY.D. (NPI 1013318062)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104096015 NPI number — ANGIER PEDIATRICS AND ADULT MEDICAL CENTER, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANGIER PEDIATRICS AND ADULT MEDICAL CENTER, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
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Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
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Provider Other Last Name:
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NPI Number Information

NPI Number:
1104096015
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/03/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
412 HOWARD GROVE PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARY
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27519-0802
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
441 LAKESTONE COMMONS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FUQUAY VARINA
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27526-6972
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-577-0481
Provider Business Practice Location Address Fax Number:
919-577-0512
Provider Enumeration Date:
03/06/2008

Additional Information

Authorized Official

Authorized Official Last Name:
UGOCHUKWU
Authorized Official First Name:
KINGSLEY
Authorized Official Middle Name:
CHUKS
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
919-234-3517

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 89136U6 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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