=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962883587
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AUGUSTINA ADDISON
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/10/2015
-----------------------------------------------------
Last Update Date | 02/16/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3130 N COUNTY ROAD 25A STE 205
-----------------------------------------------------
City | TROY
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45373-1337
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-335-1660
-----------------------------------------------------
Fax | 937-440-4020
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3170 KETTERING BLVD BLDG B3
-----------------------------------------------------
City | MORAINE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45439-1924
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-991-3188
-----------------------------------------------------
Fax | 937-223-9811
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | 35.140195
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | MT209133
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | 2022-02421
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------