Provider Demographics
NPI:1144282278
Name:AUGUSTIN, YOLA (MD)
Entity type:Individual
Prefix:
First Name:YOLA
Middle Name:
Last Name:AUGUSTIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 GREEN ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13203-2911
Mailing Address - Country:US
Mailing Address - Phone:315-425-1431
Mailing Address - Fax:
Practice Address - Street 1:311 GREEN ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13203-2911
Practice Address - Country:US
Practice Address - Phone:315-425-1431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY222318207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02377484Medicaid
NY02377484Medicaid
NYH76972Medicare UPIN