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Individual

DAVID GORDON WAGNER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
14955 SHADY GROVE RD, SUITE 125, ROCKVILLE, MD 20850-8700
(301) 765-1816
(301) 838-9712
Mailing address
14955 SHADY GROVE RD, SUITE 125, ROCKVILLE, MD 20850-8700
(301) 765-1816
(301) 838-9712

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
D0051588
MD
207W00000X
Ophthalmology Physician
0101053417
VA
207W00000X
Ophthalmology Physician
Primary
D0051588
MD
207W00000X
Ophthalmology Physician
G64967
CA
207W00000X
Ophthalmology Physician
MD20367
DC

Other

Enumeration date
07/08/2005
Last updated
10/13/2010
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