Provider Demographics
NPI:1558895813
Name:AUGUSTIN, JULIETTE (MD)
Entity Type:Individual
Prefix:
First Name:JULIETTE
Middle Name:
Last Name:AUGUSTIN
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 1:1650 HUNTINGDON PIKE STE 320
Mailing Address - Street 2:
Mailing Address - City:MEADOWBROOK
Mailing Address - State:PA
Mailing Address - Zip Code:19046-8074
Mailing Address - Country:US
Mailing Address - Phone:215-947-1447
Mailing Address - Fax:215-947-2603
Practice Address - Street 1:1650 HUNTINGDON PIKE STE 320
Practice Address - Street 2:
Practice Address - City:MEADOWBROOK
Practice Address - State:PA
Practice Address - Zip Code:19046-8074
Practice Address - Country:US
Practice Address - Phone:215-947-1447
Practice Address - Fax:215-947-2603
Is Sole Proprietor?:No
Enumeration Date:2017-04-13
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PAMD471124208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program