Provider Demographics
NPI:1699888222
Name:OLAFSDOTTIR, AGUSTA (MD)
Entity type:Individual
Prefix:
First Name:AGUSTA
Middle Name:
Last Name:OLAFSDOTTIR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 S NEW BALLAS RD STE 3016B
Mailing Address - Street 2:MERCY CLINIC ADULT HOSPITALIST
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8267
Mailing Address - Country:US
Mailing Address - Phone:314-251-6339
Mailing Address - Fax:314-251-4564
Practice Address - Street 1:621 S NEW BALLAS RD STE 3016B
Practice Address - Street 2:MERCY CLINIC ADULT HOSPITALIST
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8267
Practice Address - Country:US
Practice Address - Phone:314-251-6339
Practice Address - Fax:314-251-4564
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA36729207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0731307Medicaid
IA27800OtherWELLMARK BCBS
IAP00360480Medicare ID - Type UnspecifiedRAILROAD MC
IA27800OtherWELLMARK BCBS
IA0731307Medicaid