Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | D62561 | MD |
NPI | 1013943950 |
---|---|
Provider Name | Dr. Melvin Wagner |
First Address | Carlisle, PA 17015-9129 |
Second Address | Carlisle, PA 17015-9129 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2006 |
Last Update Date | 28/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
408597300 | (05) | MD |
I42595 | (02) | MD |