Wagner, Robert Clark

Wagner, Robert Clark is an sole proprietor health care provider with primary practice located at 1635 N George Mason Dr Suite 140, Arlington VA 22205-3601. He recently has only one registered license in Other Service Providers / Specialist, which is considered as his primary health care specialty. Wagner, Robert Clark can be contacted via phone (703) 243-7677.

Contact Information

Primary practice address
1635 N George Mason Dr Suite 140 Arlington VA 22205-3601
Fax: (703) 243-5416
Website:

Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Specialist 174400000X 0101030296 Virginia

Profile Details

NPI number 1972568293
LBN Legal business name Wagner, Robert Clark
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Apr 19th, 2006
Last updated Oct 27th, 2011 - about 14 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1972568293 NPPES
Virginia MEDICAID 7393202

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