Individual
PAUL WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
26 MOUNT ZION RD, YORK, PA 17402-2601
(717) 840-0984
(717) 755-8859
Mailing address
200 N 7TH ST, LEBANON, PA 17046-5040
(717) 272-5464
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103620423
—
PA
Enumeration date
02/18/2019
Last updated
06/24/2019
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