Provider Demographics
NPI:1336137595
Name:WAGSHUL, FRED ARTHUR (MD)
Entity Type:Individual
Prefix:DR
First Name:FRED
Middle Name:ARTHUR
Last Name:WAGSHUL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 636746
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-0001
Mailing Address - Country:US
Mailing Address - Phone:937-859-5864
Mailing Address - Fax:937-859-8858
Practice Address - Street 1:8371 YANKEE ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45458-1810
Practice Address - Country:US
Practice Address - Phone:937-859-5864
Practice Address - Fax:937-859-8858
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-054353207RP1001X
OHF09200497364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0636262Medicaid
0587315Medicare PIN
OH0636262Medicaid