Individual
MATTHEW GEORGE WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
D0034015
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001240825 0004
PA MEDICAID
MD
01
—
425459-02
BC/BS ID #
MD
05
—
5324319 00
—
MD
01
—
PVPB125341
APS PROVIDER ID
MD
Enumeration date
07/12/2006
Last updated
03/13/2012
Update your record
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