Basic Information
| Provider Information | |||||||||
| NPI: | 1447208392 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FERGUSON | ||||||||
| FirstName: | MARTHA | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3200 BURNET AVE | ||||||||
| Address2: | 3 SOUTH, CREDENTIALING | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452293019 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5134758787 | ||||||||
| FaxNumber: | 5139294369 | ||||||||
| Practice Location | |||||||||
| Address1: | 2123 AUBURN AVE. | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 45219 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5134758787 | ||||||||
| FaxNumber: | 5139294369 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2006 | ||||||||
| LastUpdateDate: | 07/09/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208C00000X | 050579 | GA | N | Allopathic & Osteopathic Physicians | Colon & Rectal Surgery | 208C00000X | 35068079 | OH | N | Allopathic & Osteopathic Physicians | Colon & Rectal Surgery | 208C00000X | 35.068079 | OH | Y | Allopathic & Osteopathic Physicians | Colon & Rectal Surgery |
ID Information
| ID | Type | State | Issuer | Description | 1400016 | 01 | UNITED HEALTHCARE | OTHER | 2668428 | 01 | AETNA HMO | OTHER | 7494880 | 01 | CIGNA HMO | OTHER | 7100083470 | 05 | KY | MEDICAID | 200960570 | 05 | IN | MEDICAID | 2125926 | 05 | OH | MEDICAID | 00928848A | 05 | GA | MEDICAID | 52821623 | 01 | BCBS | OTHER | 1288 | 01 | KAISER | OTHER | 5106771 | 01 | AETNA NON HMO | OTHER |