Provider Demographics
NPI:1134291347
Name:WAGNER MEDICAL ASSOCIATES
Entity Type:Organization
Organization Name:WAGNER MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:WAGNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:828-787-2430
Mailing Address - Street 1:209 HOSPITAL DR
Mailing Address - Street 2:SUITE 203
Mailing Address - City:HIGHLANDS
Mailing Address - State:NC
Mailing Address - Zip Code:28741-7623
Mailing Address - Country:US
Mailing Address - Phone:828-787-2430
Mailing Address - Fax:
Practice Address - Street 1:209 HOSPITAL DR
Practice Address - Street 2:SUITE 203
Practice Address - City:HIGHLANDS
Practice Address - State:NC
Practice Address - Zip Code:28741-7623
Practice Address - Country:US
Practice Address - Phone:828-787-2430
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2341635Medicare ID - Type Unspecified