Provider Demographics
NPI:1740377076
Name:AUGOUSTIDES, ALEXANDER T (MD)
Entity type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:T
Last Name:AUGOUSTIDES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1411 PLAZA WEST ROAD
Mailing Address - Street 2:SUITE B
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103
Mailing Address - Country:US
Mailing Address - Phone:336-760-0240
Mailing Address - Fax:336-760-4568
Practice Address - Street 1:1411 PLAZA WEST ROAD
Practice Address - Street 2:SUITE B
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103
Practice Address - Country:US
Practice Address - Phone:336-760-0240
Practice Address - Fax:336-760-4568
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC36139207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
137XHOtherBCBS
E96911Medicare UPIN
2180568FMedicare ID - Type Unspecified