Active NPI
Amelia V Agustin, MD
- Pediatrics Physician
- Cranberry TWP, PA
National Provider Identifier
1619944774
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- MD035077L
- Practice address
- 20397 Route 19
Two Landmark North Suite 220
Cranberry TWP, PA 16066 - Phone
- (724) 772-5430
- Fax
- (724) 772-5431
- NPI assigned
- Mar 7, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | MD035077L | PA | Primary |
Addresses
Primary practice location
20397 Route 19
Two Landmark North Suite 220
Cranberry TWP, PA 16066
Mailing address
20397 Route 19
Two Landmark North Suite 220
Cranberry TWP, PA 16066
Phone (724) 772-5430
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000690637006 | Medicaid | PA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD035077L | PA | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1141689600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1331164800000",
"number": "1619944774",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "20397 ROUTE 19",
"address_2": "TWO LANDMARK NORTH SUITE 220",
"city": "CRANBERRY TWP",
"state": "PA",
"postal_code": "16066",
"telephone_number": "724-772-5430",
"fax_number": "724-772-5431"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "20397 ROUTE 19",
"address_2": "TWO LANDMARK NORTH SUITE 220",
"city": "CRANBERRY TWP",
"state": "PA",
"postal_code": "16066",
"telephone_number": "724-772-5430",
"fax_number": "724-772-5431"
}
],
"practiceLocations": [],
"basic": {
"last_name": "AGUSTIN",
"first_name": "AMELIA",
"middle_name": "V",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-03-07",
"last_updated": "2012-03-08",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "PA",
"license": "MD035077L",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000690637006",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Cranberry TWP, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.