Individual
WILLIAM WAGLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
711 TROY SCHENECTADY RD, SUITE 114, LATHAM, NY 12110-2442
(518) 786-1600
Mailing address
711 TROY SCHENECTADY RD, SUITE 201, LATHAM, NY 12110-2442
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
158522
NY
2085N0700X
Neuroradiology Physician
158522
NY
2085R0202X
Diagnostic Radiology Physician
Primary
158522
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00987637
—
NY
Enumeration date
10/25/2006
Last updated
12/08/2007
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