Wagoner, Gary L
Wagoner, Gary L is an sole proprietor health care provider with primary practice located at 925 Bishop Walsh Rd Suite 4, Cumberland MD 21502. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Wagoner, Gary L can be contacted via phone (301) 777-5326.Contact Information
Primary practice address
925 Bishop Walsh Rd Suite 4
Cumberland MD 21502
Phone: (301) 777-5326
Fax: (301) 777-0325
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | D0022181 | Maryland |
Profile Details
| NPI number | 1225034853 |
|---|---|
| LBN Legal business name | Wagoner, Gary L |
| Credentials | MD P A |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jun 28th, 2005 |
| Last updated | Sep 18th, 2018 - about 8 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1225034853 | NPPES |
| Maryland | MEDICAID | 189121900 | |
| Maryland | Other | 218706 | |
| Maryland | Other | P11723 | |
| Maryland | Other | 8814GL | |
| Maryland | Other | W0230001 | |
| Maryland | Other | 104012109 | |
| Maryland | Other | 408113495 |
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