Provider Demographics
NPI:1962582189
Name:FERGUSON, ROLLINGTON (MD)
Entity type:Individual
Prefix:DR
First Name:ROLLINGTON
Middle Name:
Last Name:FERGUSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MISS
Other - First Name:MARION
Other - Middle Name:
Other - Last Name:OROZCO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:368 28TH STREET
Mailing Address - Street 2:SUITE A
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-3601
Mailing Address - Country:US
Mailing Address - Phone:510-465-7382
Mailing Address - Fax:510-465-7465
Practice Address - Street 1:368 28TH STREET
Practice Address - Street 2:SUITE A
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3601
Practice Address - Country:US
Practice Address - Phone:510-465-7382
Practice Address - Fax:510-465-7465
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00G72372207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G723722Medicaid
CA00G723722Medicaid
CA00G723721Medicare PIN