1033808704 NPI number — DR. ODOLPHE AUGUSTIN DO, MPH

Table of content: DR. ODOLPHE AUGUSTIN DO, MPH (NPI 1033808704)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033808704 NPI number — DR. ODOLPHE AUGUSTIN DO, MPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AUGUSTIN
Provider First Name:
ODOLPHE
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DO, MPH
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033808704
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/08/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4940 EASTERN AVENUE
Provider Second Line Business Mailing Address:
INTERNAL MEDICINE CLINIC
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21224
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-550-3350
Provider Business Mailing Address Fax Number:
410-550-0491

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4940 EASTERN AVENUE
Provider Second Line Business Practice Location Address:
INTERNAL MEDICINE CLINIC
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21224
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-550-3350
Provider Business Practice Location Address Fax Number:
410-550-0491
Provider Enumeration Date:
05/08/2023

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)