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Individual

DR. PETER B WAGNER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
D.O.

Contact information

Practice address
115 HEART DR, GREENVILLE, NC 27834-8982
(252) 744-4400
(252) 744-3987
Mailing address
PO BOX 751069, CHARLOTTE, NC 28275-1069

Taxonomy

Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
9500471
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
060033560
RAILROAD MEDICARE
NC
01
561638624
COMMERCIAL PAYERS
01
58761
MEDCOST
NC
01
85205
BCBS
NC
05
8985205
NC
Enumeration date
03/16/2006
Last updated
03/11/2024
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