Provider Demographics
NPI:1710710918
Name:FERGUSON, TAMARA (LAC)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 SUNSHINE PL APT B
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-1746
Mailing Address - Country:US
Mailing Address - Phone:301-850-8335
Mailing Address - Fax:
Practice Address - Street 1:5457 TWIN KNOLLS RD STE 300N5-5
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-3259
Practice Address - Country:US
Practice Address - Phone:410-575-3688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-22
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU03136171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist