Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | D0072106 | MD |
N | 2084N0600X | Clinical Neurophysiologist | D0072106 | MD |
NPI | 1508075276 |
---|---|
Provider Name | Sheetal Harish Wagle |
First Address | Columbia, MD 21044-3646 |
Second Address | Columbia, MD 21044-3646 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2007 |
Last Update Date | 30/11/2011 |