Healthcare Provider Details

I. General information

NPI: 1750556452
Provider Name (Legal Business Name): ANN AUGUSTINE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2008
Last Update Date: 11/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 S PROSPECT ST ARNOLD 2
BURLINGTON VT
05401-3456
US

IV. Provider business mailing address

1 S PROSPECT ST ARNOLD 2
BURLINGTON VT
05401-3456
US

V. Phone/Fax

Practice location:
  • Phone: 802-847-5338
  • Fax: 802-847-0379
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number042-0012285
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: