Provider Demographics
NPI:1164450243
Name:AGUSTIN PEDIATRICS
Entity Type:Organization
Organization Name:AGUSTIN PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AMELIA
Authorized Official - Middle Name:V
Authorized Official - Last Name:AGUSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-772-5430
Mailing Address - Street 1:20397 ROUTE 19
Mailing Address - Street 2:TWO LANDMARK NORTH, SUITE 220
Mailing Address - City:CRANBERRY TWP
Mailing Address - State:PA
Mailing Address - Zip Code:16066-6133
Mailing Address - Country:US
Mailing Address - Phone:724-772-5430
Mailing Address - Fax:724-772-5431
Practice Address - Street 1:20397 ROUTE 19
Practice Address - Street 2:TWO LANDMARK NORTH, SUITE 220
Practice Address - City:CRANBERRY TWP
Practice Address - State:PA
Practice Address - Zip Code:16066-6133
Practice Address - Country:US
Practice Address - Phone:724-772-5430
Practice Address - Fax:724-772-5431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty