Provider Demographics
NPI:1194704205
Name:AUGUSTIN, DONALD W (PAC)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:W
Last Name:AUGUSTIN
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3012
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19804-0012
Mailing Address - Country:US
Mailing Address - Phone:800-456-4629
Mailing Address - Fax:302-224-5678
Practice Address - Street 1:100 EAST CARROLL STREET
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801
Practice Address - Country:US
Practice Address - Phone:410-543-7100
Practice Address - Fax:410-546-6350
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0002223363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
56UUMedicare ID - Type Unspecified
O04146Medicare UPIN
5450Medicare ID - Type Unspecified