Provider Demographics
NPI:1407960966
Name:AUGUSTINE, MARILYN (MD)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:
Last Name:AUGUSTINE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 ELMWOOD AVE
Mailing Address - Street 2:BOX MED
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-1000
Mailing Address - Country:US
Mailing Address - Phone:585-275-2901
Mailing Address - Fax:585-273-1288
Practice Address - Street 1:601 ELMWOOD AVE
Practice Address - Street 2:BOX MED
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14642-0001
Practice Address - Country:US
Practice Address - Phone:585-275-2901
Practice Address - Fax:585-273-1288
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD444995207RE0101X
NY248120207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism