Individual
MR. JOEL I WAGMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
251 E BRINGHURST ST, PHILADELPHIA, PA 19144-1719
(215) 844-1020
(215) 844-2702
Mailing address
251 E BRINGHURST ST, PHILADELPHIA, PA 19144-1719
(215) 844-1020
(215) 844-2702
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
9291
NH
207Q00000X
Family Medicine Physician
Primary
MD051924L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1007564460003
—
PA
01
—
391960
MEDICARE FQHC
PA
Enumeration date
09/07/2005
Last updated
11/18/2011
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