Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | P28798 | MD |
NPI | 1235570839 |
---|---|
Provider Name | Dr. Pablo Wagner |
First Address | Baltimore, MD 21215-5216 |
Second Address | Baltimore, MD 21215-5216 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2013 |
Last Update Date | 11/07/2013 |