Healthcare Provider Details

I. General information

NPI: 1194704205
Provider Name (Legal Business Name): DONALD W AUGUSTIN PAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 07/18/2025
Certification Date: 07/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 EAST CARROLL STREET
SALISBURY MD
21801
US

IV. Provider business mailing address

6201 GREENLEIGH AVE
MIDDLE RIVER MD
21220-2004
US

V. Phone/Fax

Practice location:
  • Phone: 410-543-7100
  • Fax: 410-546-6350
Mailing address:
  • Phone: 410-740-7544
  • Fax: 410-500-4266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC0002223
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: