Individual
JASON E WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3400 CIVIC CENTER BLVD, WEST PAVILION 1ST FL, PHILADELPHIA, PA 19104-5127
(215) 662-3202
Mailing address
3400 CIVIC CENTER BLVD, WEST PAVILION 1ST FL, PHILADELPHIA, PA 19104-5127
(215) 662-3202
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MD435611
PA
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
Primary
MD435611
PA
207RP1001X
Pulmonary Disease Physician
MD435611
PA
Other
Enumeration date
12/27/2006
Last updated
09/27/2019
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