Provider Demographics
NPI:1053330456
Name:AUGUSTINE, JOSHUA J (MD)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:J
Last Name:AUGUSTINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:9500 EUCLID AVE
Mailing Address - Street 2:MAILSTOP Q7
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44195-0001
Mailing Address - Country:US
Mailing Address - Phone:216-445-4926
Mailing Address - Fax:216-444-9378
Practice Address - Street 1:9500 EUCLID AVE
Practice Address - Street 2:MAILSTOP Q7
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-0001
Practice Address - Country:US
Practice Address - Phone:216-445-4926
Practice Address - Fax:216-444-9378
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-082423207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000224449OtherUNISON
OH2480828Medicaid
363327OtherWELLCARE
000000539415OtherANTHEM
7022582OtherAETNA
741796OtherBUCKEYE
OHP00203479OtherRAILROAD MEDICARE
AU4132593Medicare PIN
000000224449OtherUNISON
OHP00203479OtherRAILROAD MEDICARE
7022582OtherAETNA