Individual
DR. JOHN HARVEY WAGONER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D., PH.D., MBA
Contact information
Practice address
133 OLD SOLOMONS ISLAND ROAD, BAYSHORE COUNSELING AND PSYCHOLOGICAL SERVICES, LLC, ANNAPOLIS, MD 21401
(410) 266-9747
(410) 266-9749
Mailing address
133 OLD SOLOMONS ISLAND ROAD, ANNAPOLIS, MD 21401
(410) 266-9747
(410) 266-9749
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
03283
MD
2084P0800X
Psychiatry Physician
Primary
D48079
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
54297601
BCBS OF MD
MD
Enumeration date
12/18/2006
Last updated
12/04/2013
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