Healthcare Provider Details

I. General information

NPI: 1104805175
Provider Name (Legal Business Name): TAMIKA AUGUSTE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2006
Last Update Date: 02/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 IRVING ST NW ROOM 5B-54
WASHINGTON DC
20010-2976
US

IV. Provider business mailing address

PO BOX 418498
BOSTON MA
02241-8498
US

V. Phone/Fax

Practice location:
  • Phone: 202-877-8177
  • Fax:
Mailing address:
  • Phone: 703-558-1544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD034859
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: