Provider Demographics
NPI:1730162660
Name:AUGUSTHY, ROY K (MD)
Entity type:Individual
Prefix:DR
First Name:ROY
Middle Name:K
Last Name:AUGUSTHY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1000 DENSTON DR
Mailing Address - Street 2:
Mailing Address - City:AMBLER
Mailing Address - State:PA
Mailing Address - Zip Code:19002
Mailing Address - Country:US
Mailing Address - Phone:215-483-8605
Mailing Address - Fax:215-487-6495
Practice Address - Street 1:5735 RIDGE AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19128
Practice Address - Country:US
Practice Address - Phone:215-483-8605
Practice Address - Fax:215-643-6323
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-23
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD02677Y2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMA1064343Medicaid
MDAU195878Medicare ID - Type Unspecified
B41087Medicare UPIN