Provider Demographics
NPI:1538127055
Name:BALUYOT, AGUSTINA A (MD)
Entity Type:Individual
Prefix:
First Name:AGUSTINA
Middle Name:A
Last Name:BALUYOT
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:PO BOX 635283
Mailing Address - Street 2:ST ELIZABETH PHYSICIANS
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:859-331-7234
Mailing Address - Fax:859-578-7986
Practice Address - Street 1:2380 GRANDVIEW DR
Practice Address - Street 2:ST ELIZABETH PHYSICIANS
Practice Address - City:FT MITCHELL
Practice Address - State:KY
Practice Address - Zip Code:41017-1633
Practice Address - Country:US
Practice Address - Phone:859-331-7234
Practice Address - Fax:859-578-7986
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2015-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY186492084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY170254OtherPHCS
KY030214000OtherMAGELLAN
KY038616OtherVALUE OPTIONS
KY64186497Medicaid
KY000000017508OtherANTHEM
KY1047301Medicare PIN
KY030214000OtherMAGELLAN