Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | MD461020 | PA |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | MD461020 | PA |
NPI | 1295147908 |
---|---|
Provider Name | Dr. Ruth Anne Wagner |
First Address | Lancaster, PA 17601 |
Second Address | Lancaster, PA 17601 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/05/2014 |
Last Update Date | 14/01/2019 |