Basic Information
| Provider Information | |||||||||
| NPI: | 1053330456 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AUGUSTINE | ||||||||
| FirstName: | JOSHUA | ||||||||
| MiddleName: | J | ||||||||
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| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9500 EUCLID AVE | ||||||||
| Address2: | MAILSTOP Q7 | ||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441950001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2164454926 | ||||||||
| FaxNumber: | 2164449378 | ||||||||
| Practice Location | |||||||||
| Address1: | 9500 EUCLID AVE | ||||||||
| Address2: | MAILSTOP Q7 | ||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441950001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2164454926 | ||||||||
| FaxNumber: | 2164449378 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2006 | ||||||||
| LastUpdateDate: | 01/19/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | 35-082423 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
| ID | Type | State | Issuer | Description | 000000224449 | 01 | UNISON | OTHER | 2480828 | 05 | OH | MEDICAID | 363327 | 01 | WELLCARE | OTHER | 000000539415 | 01 | ANTHEM | OTHER | 7022582 | 01 | AETNA | OTHER | 741796 | 01 | BUCKEYE | OTHER | P00203479 | 01 | OH | RAILROAD MEDICARE | OTHER |