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Organization
GARY L WAGONER MD P A
Active
Organization
GARY L WAGONER MD P A
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GARY L WAGONER MD P A (OWNER)
(301) 777-5326
Entity
Organization
Contact information
Practice address
925 BISHOP WALSH RD, SUITE 4, CUMBERLAND, MD 21502-1845
(301) 777-5326
Mailing address
925 BISHOP WALSH RD, SUITE 4, CUMBERLAND, MD 21502-1845
(301) 777-5326
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
D00822181
MD
Other
Enumeration date
03/01/2011
Last updated
09/20/2018
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