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1760555494

NPI Code Detail

MEDICARE: DR. MAVICTORIA AGUSTIN MD

MEDICARE: DR. MAVICTORIA AGUSTIN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	2010-00505	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760555494
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MAVICTORIA AGUSTIN MD

Provider Business Mailing Address
First Line	:	PO BOX 1090
Second Line	:
City	:	HARTSVILLE
State	:	SC
Zip	:	29551-1090
Country	:	US
Telephone Number	:	843-857-0111
Fax Number	:	843-857-0206

Provider Business Practice Location Address
First Line	:	545 SUMTER HWY
Second Line	:
City	:	BISHOPVILLE
State	:	SC
Zip	:	29010-7601
Country	:	US
Telephone Number	:	803-484-5317
Fax Number	:	803-484-4533

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/17/2006
Last Update Date	:	10/27/2014

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Directions to “ DR. MAVICTORIA AGUSTIN MD” Practice Location

Language	Start Address	Practice Location

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