Basic Information
Provider Information | |||||||||
NPI: | 1205891710 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | FOJAS | ||||||||
FirstName: | AUGUSTO | ||||||||
MiddleName: | PARAS | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 401 MARKET ST | ||||||||
Address2: | SUITE 1000 | ||||||||
City: | STEUBENVILLE | ||||||||
State: | OH | ||||||||
PostalCode: | 439522881 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7402827386 | ||||||||
FaxNumber: | 7402841754 | ||||||||
Practice Location | |||||||||
Address1: | 1878 FRANKLIN ST | ||||||||
Address2: |   | ||||||||
City: | TORONTO | ||||||||
State: | OH | ||||||||
PostalCode: | 439641949 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7405375055 | ||||||||
FaxNumber: | 7405375060 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/18/2006 | ||||||||
LastUpdateDate: | 06/14/2010 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 35034112 | OH | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine |   |
ID Information
ID | Type | State | Issuer | Description | 112130665 | 01 | OH | RR MEDICARE | OTHER | 0072566000 | 05 | WV |   | MEDICAID | 0214191 | 05 | OH |   | MEDICAID |