Individual
DR. GARY L WAGONER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD P A
Contact information
Practice address
925 BISHOP WALSH RD, SUITE 4, CUMBERLAND, MD 21502
(301) 777-5326
(301) 777-0325
Mailing address
925 BISHOP WALSH RD, CUMBERLAND, MD 21502-1845
(301) 777-5326
(301) 777-0325
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
D0022181
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
104012109
CIGNA
MD
05
—
189121900
—
MD
01
—
218706
UNITED HEALTH CARE
MD
01
—
408113495
R.R. MEDICARE
MD
01
—
8814GL
CAREFIRST BS
MD
01
—
P11723
BLUE SHIELD POS
MD
01
—
W0230001
FEDERAL BS
MD
Enumeration date
06/28/2005
Last updated
09/18/2018
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