Individual
ROBERT CLARK WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1635 N GEORGE MASON DR, SUITE 140, ARLINGTON, VA 22205-3601
(703) 243-7677
(703) 243-5416
Mailing address
1635 N GEORGE MASON DR, SUITE 140, ARLINGTON, VA 22205-3601
(703) 243-7677
(703) 243-5416
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
0101030296
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7393202
—
VA
Enumeration date
04/19/2006
Last updated
10/27/2011
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