Gary L Wagoner Md P A | |
925 Bishop Walsh Rd Suite 4 Cumberland MD 21502-1845 | |
(301) 777-5326 | |
Not Available |
Full Name | Gary L Wagoner Md P A |
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Speciality | Family Medicine |
Location | 925 Bishop Walsh Rd, Cumberland, Maryland |
Authorized Official Name and Position | Gary L Wagoner (OWNER) |
Authorized Official Contact | 3017775326 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Gary L Wagoner Md P A 925 Bishop Walsh Rd Suite 4 Cumberland MD 21502-1845 Ph: (301) 777-5326 | Gary L Wagoner Md P A 925 Bishop Walsh Rd Suite 4 Cumberland MD 21502-1845 Ph: (301) 777-5326 |
NPI Number | 1619275617 |
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Provider Enumeration Date | 03/01/2011 |
Last Update Date | 09/20/2018 |
Medicare PECOS PAC ID | 6800077504 |
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Medicare Enrollment ID | O20110301000800 |
Identifier | Type | State | Issuer |
---|---|---|---|
1619275617 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | D00822181 (Maryland) | Primary |
Provider Name | Gary L Wagoner |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1225034853 PECOS PAC ID: 1557542834 Enrollment ID: I20110218000779 |
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