Individual
CHARLES ALLEN WAGNER JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
300 HOLLYWOOD BLVD, ORWIGSBURG, PA 17961-2426
(570) 366-1557
Mailing address
100 N ACADEMY AVE, DANVILLE, PA 17822-4903
(570) 271-6144
(570) 271-6578
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
OS008546L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0016970330010
—
PA
Enumeration date
04/26/2006
Last updated
10/14/2020
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