Provider Demographics
NPI:1659373843
Name:AUGUSTITUS, VIRGINIA KAREN (MD)
Entity Type:Individual
Prefix:DR
First Name:VIRGINIA
Middle Name:KAREN
Last Name:AUGUSTITUS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:V.
Other - Middle Name:KAREN
Other - Last Name:AUGUSTITUS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1707 COLE BLVD
Mailing Address - Street 2:STE 100
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80401-3220
Mailing Address - Country:US
Mailing Address - Phone:303-716-8013
Mailing Address - Fax:303-763-5495
Practice Address - Street 1:165 S UNION BLVD
Practice Address - Street 2:STE 800
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-2213
Practice Address - Country:US
Practice Address - Phone:303-988-2680
Practice Address - Fax:303-986-8057
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO28010207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01280106Medicaid
CON1334Medicare ID - Type Unspecified
CO01280106Medicaid