Provider Demographics
NPI:1093737553
Name:D'AUGUSTINE, GREGORY (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:
Last Name:D'AUGUSTINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1849
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04241-1849
Mailing Address - Country:US
Mailing Address - Phone:207-784-2554
Mailing Address - Fax:207-777-5363
Practice Address - Street 1:10 HIGH ST
Practice Address - Street 2:SUITE 202
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-7640
Practice Address - Country:US
Practice Address - Phone:207-784-2903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME010697208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME3544908OtherCIGNA
ME4002657OtherAETNA-NON HMO
MEE001664OtherCHAMPUS
MEE34486OtherHARVARD
ME0931737OtherAETNA
ME002313OtherANTHEM BCBS
MEM58331OtherCIGNA HEALTHSOURCE
MEM58331OtherCIGNA HEALTHSOURCE
ME015176Medicare ID - Type Unspecified