Mavictoria Agustin, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

2010-00505 Issued in NC

Practice address

545 Sumter Hwy
Bishopville, SC 29010-7601

Phone

(803) 484-5317

Fax

(803) 484-4533

NPI assigned

Nov 17, 2006

Last updated

Oct 27, 2014By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163721600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1414368000000",
    "number": "1760555494",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1090",
            "city": "HARTSVILLE",
            "state": "SC",
            "postal_code": "295511090",
            "telephone_number": "843-857-0111",
            "fax_number": "843-857-0206"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "545 SUMTER HWY",
            "city": "BISHOPVILLE",
            "state": "SC",
            "postal_code": "290107601",
            "telephone_number": "803-484-5317",
            "fax_number": "803-484-4533"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AGUSTIN",
        "first_name": "MAVICTORIA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-17",
        "last_updated": "2014-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NC",
            "license": "2010-00505",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201000505",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8902644",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "410323800",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "355715",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Pediatrics Physician in Bishopville, SC
• Providers in Bishopville, SC by specialty
• Pediatrics Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.