Agustin, Mavictoria

Agustin, Mavictoria is an individual health care provider with primary practice located at 545 Sumter Hwy , Bishopville SC 29010-7601. She recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as her primary health care specialty. Agustin, Mavictoria can be contacted via phone (803) 484-5317.

Contact Information

Primary practice address
545 Sumter Hwy Bishopville SC 29010-7601
Phone: (803) 484-5317
Fax: (803) 484-4533
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 2010-00505 North Carolina

Profile Details

NPI number 1760555494
LBN Legal business name Agustin, Mavictoria
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 17th, 2006
Last updated Oct 27th, 2014 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1760555494 NPPES
Maryland MEDICAID 410323800
Maryland MEDICAID 8902644
Maryland MEDICAID 355715
Maryland MEDICAID 201000505

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