Individual
REBECCA LEIGH WAGSTAFF
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
101 E WOOD ST, SPARTANBURG, SC 29303-3040
(864) 560-4304
Mailing address
PO BOX 743070, ATLANTA, GA 30374-3070
(864) 560-4304
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
25607
SC
207RH0002X
Hospice and Palliative Medicine (Internal Medicine) Physician
203441
LA
208M00000X
Hospitalist Physician
203441
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03087834
—
MS
05
—
1811726
—
LA
05
—
256074
—
SC
01
—
3283927
CIGNA ID
SC
01
—
576007863071
BLUECHOICE HEALTHPLAN ID
SC
01
—
576007863095
BCBS OF SC ID
SC
01
—
7027607
AETNA ID
SC
01
—
P00113665
RR MEDICARE
SC
01
—
P01577390
RAILROAD MEDICARE
SC
01
—
SC75725019
MEDICARE PIN
SC
01
—
SC75729068
MEDICARE PIN
SC
Enumeration date
05/05/2006
Last updated
01/12/2021
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