| Scott Wagner Integrated Medicine Llc | |
|
2109 India Rd Charlottesville VA 22901-2886 | |
| (434) 978-4888 | |
| Not Available |
| Full Name | Scott Wagner Integrated Medicine Llc |
|---|---|
| Speciality | General Practice |
| Location | 2109 India Rd, Charlottesville, Virginia |
| Authorized Official Name and Position | Scott Brian Wagner (AUTHORIZED OFFICIAL) |
| Authorized Official Contact | 4349784888 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Scott Wagner Integrated Medicine Llc 2109 India Rd Charlottesville VA 22901-2886 Ph: (434) 978-4888 | Scott Wagner Integrated Medicine Llc 2109 India Rd Charlottesville VA 22901-2886 Ph: (434) 978-4888 |
| NPI Number | 1447875042 |
|---|---|
| Provider Enumeration Date | 06/10/2020 |
| Last Update Date | 06/20/2023 |
| Medicare PECOS PAC ID | 1153749825 |
|---|---|
| Medicare Enrollment ID | O20200911001172 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447875042 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Scott D Chirichetti |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1487723003 PECOS PAC ID: 5395774194 Enrollment ID: I20050811000724 |
| Provider Name | Scott Brian Wagner |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1053340588 PECOS PAC ID: 1153446489 Enrollment ID: I20100910000072 |
| Provider Name | Nicholas Butterworth |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1568065332 PECOS PAC ID: 1850704305 Enrollment ID: I20231214000782 |
| Provider Name | Stephen Black |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1932392883 PECOS PAC ID: 1052484086 Enrollment ID: I20231218001055 |
| Provider Name | Lisa Goldstein |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861055907 PECOS PAC ID: 8224412382 Enrollment ID: I20240112003449 |
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