Healthcare Provider Details

I. General information

NPI: 1245527514
Provider Name (Legal Business Name): ANASTAZIA MARIE AGIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2011
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

721 MIAMI CHAPEL RD
DAYTON OH
45417-4650
US

IV. Provider business mailing address

2702 EDNA LN
SPRINGFIELD OH
45503-1807
US

V. Phone/Fax

Practice location:
  • Phone: 937-281-6800
  • Fax:
Mailing address:
  • Phone: 614-537-3036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number35.122283
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35.122283
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: