Provider Demographics
NPI:1073010823
Name:WAGNER, WILLIAM PRICE (DO)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:PRICE
Last Name:WAGNER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 E PARK AVE
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16803-6701
Mailing Address - Country:US
Mailing Address - Phone:814-231-7100
Mailing Address - Fax:814-238-0790
Practice Address - Street 1:141 MEDICAL PARK LN
Practice Address - Street 2:
Practice Address - City:BELLEFONTE
Practice Address - State:PA
Practice Address - Zip Code:16823-9112
Practice Address - Country:US
Practice Address - Phone:814-355-7322
Practice Address - Fax:814-355-9604
Is Sole Proprietor?:No
Enumeration Date:2018-04-09
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS021538207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine