Provider Demographics
NPI:1689663700
Name:AUGUSTINE, SANTHOSH (MD)
Entity type:Individual
Prefix:
First Name:SANTHOSH
Middle Name:
Last Name:AUGUSTINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 W 27TH ST
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-3014
Mailing Address - Country:US
Mailing Address - Phone:910-739-0770
Mailing Address - Fax:910-739-4102
Practice Address - Street 1:101 W 27TH ST
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-3014
Practice Address - Country:US
Practice Address - Phone:910-739-0770
Practice Address - Fax:910-739-4102
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC96-00445207RG0100X
NC9600445207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8912277Medicaid
NC19AKQOtherBCBS
G00202Medicare UPIN
NC8912277Medicaid