Individual
MRS. RENEE WAGNER MACSORLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
9450 PENNSYLVANIA AVE, STE. 15, UPPER MARLBORO, MD 20772-3665
(301) 599-6300
Mailing address
9450 PENNSYLVANIA AVE, STE. 15, UPPER MARLBORO, MD 20772-3665
(301) 599-6300
Taxonomy
Speciality
Code
Description
License number
State
156FX1700X
Ocularist
Primary
—
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
023053600
—
DC
01
—
30877
KAISER PERMANENTE
MD
01
—
406540466
MEDICARE RR
DC
05
—
468228900
—
MD
Enumeration date
05/21/2008
Last updated
05/21/2008
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