Provider Demographics
NPI:1275330490
Name:FERGUSON, GREGORY ALLAN
Entity type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:ALLAN
Last Name:FERGUSON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1530 BATTERY HILL DR
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23231-8140
Mailing Address - Country:US
Mailing Address - Phone:804-517-2124
Mailing Address - Fax:
Practice Address - Street 1:1530 BATTERY HILL DR
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23231-8140
Practice Address - Country:US
Practice Address - Phone:804-517-2124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-26
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0735001008175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty