Healthcare Provider Details

I. General information

NPI: 1407960966
Provider Name (Legal Business Name): MARILYN AUGUSTINE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 07/06/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 ELMWOOD AVE BOX MED
ROCHESTER NY
14642-0001
US

IV. Provider business mailing address

601 ELMWOOD AVE BOX MED
ROCHESTER NY
14642-1000
US

V. Phone/Fax

Practice location:
  • Phone: 585-275-2901
  • Fax: 585-273-1288
Mailing address:
  • Phone: 585-275-2901
  • Fax: 585-273-1288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberMD444995
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number248120
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: