Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251C2600X | Cardiopulmonary | PT008882L | PA |
NPI | 1396075362 |
---|---|
Provider Name | Eugene Anthony Wagner |
First Address | North Huntingdon, PA 15642-1980 |
Second Address | Mckeesport, PA 15132-2422 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/01/2010 |
Last Update Date | 18/03/2021 |