Individual
MARK WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS, ATC
Contact information
Practice address
600 CORNELL AVE, HAGERSTOWN, MD 21742-4500
(301) 733-5006
Mailing address
600 CORNELL AVE, HAGERSTOWN, MD 21742-4500
(301) 733-5006
Taxonomy
Speciality
Code
Description
License number
State
174H00000X
Health Educator
Primary
0126001123
VA
Other
Enumeration date
03/16/2015
Last updated
03/16/2015
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