Ferguson-Avery, Sally Jo

Ferguson-Avery, Sally Jo is an sole proprietor health care provider with primary practice located at 3057 N Susquehanna Trl , Shamokin Dam PA 17876-9114. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Pediatrics, Allopathic & Osteopathic Physicians / Internal Medicine. Allopathic & Osteopathic Physicians / Internal Medicine is her primary health care specialty. Ferguson-Avery, Sally Jo can be contacted via phone (570) 743-1112.

Contact Information

Primary practice address
3057 N Susquehanna Trl Shamokin Dam PA 17876-9114
Phone: (570) 743-1112
Fax: (570) 743-1114
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X MD423495 Pennsylvania
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X MD423495 Pennsylvania

Profile Details

NPI number 1508805615
LBN Legal business name Ferguson-Avery, Sally Jo
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jun 5th, 2006
Last updated Apr 15th, 2022 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1508805615 NPPES
Pennsylvania MEDICAID 1009301640002

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