Individual
RICHARD JOHN WAGNER JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
5515 PEACH ST, ERIE, PA 16509-2695
(814) 864-4031
Mailing address
1 LECOM PL, ERIE, PA 16505-2571
(814) 868-2507
(814) 868-2522
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
OS022870
PA
390200000X
Student in an Organized Health Care Education/Training Program
OT020105
PA
Other
Enumeration date
06/16/2020
Last updated
09/14/2023
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