Individual
DR. JOHN THOMAS WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
819 MOUNT ROYAL BLVD, PITTSBURGH, PA 15223-1244
(412) 492-9006
(412) 492-0938
Mailing address
819 MOUNT ROYAL BLVD, PITTSBURGH, PA 15223-1244
(412) 492-9006
(412) 492-0938
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
SC003667R
PA
213ES0103X
Foot & Ankle Surgery Podiatrist
SC003667R
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001408328009
—
PA
Enumeration date
07/27/2005
Last updated
06/15/2010
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