# GARY L WAGONER MD P A

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1619275617
- **Authorized official:** GARY L WAGONER MD P A (OWNER)
- **Authorized official phone:** (301) 777-5326

## Contact information

- **Practice address:** 925 BISHOP WALSH RD, SUITE 4, CUMBERLAND, MD 21502-1845
- **Practice address phone:** (301) 777-5326
- **Mailing address:** 925 BISHOP WALSH RD, SUITE 4, CUMBERLAND, MD 21502-1845
- **Mailing address phone:** (301) 777-5326

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | D00822181 | MD | Yes |

## Other

- **Enumeration date:** 03/01/2011
- **Last updated:** 09/20/2018