Basic Information
Provider Information | |||||||||
NPI: | 1811556012 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | RAWLINS-RADER | ||||||||
FirstName: | AUGUSTA | ||||||||
MiddleName: | MALIN | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | RADER | ||||||||
OtherFirstName: | AUGUSTA | ||||||||
OtherMiddleName: | MALIN RAWLINS | ||||||||
OtherNamePrefix: | DR. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | MD | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 2100 SHERMAN AVE FL 4 | ||||||||
Address2: |   | ||||||||
City: | CINCINNATI | ||||||||
State: | OH | ||||||||
PostalCode: | 452122791 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5133519900 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 1955 DIXIE HWY | ||||||||
Address2: |   | ||||||||
City: | FT WRIGHT | ||||||||
State: | KY | ||||||||
PostalCode: | 410112792 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8593415757 | ||||||||
FaxNumber: | 8593314757 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/11/2019 | ||||||||
LastUpdateDate: | 10/21/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 10/21/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 55673 | KY | Y |   | Allopathic & Osteopathic Physicians | Family Medicine |   |
No ID Information.