Provider Demographics
NPI:1356306187
Name:WAGAR, DAVID A (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:WAGAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:8110 MAPLE LAWN BLVD STE 235
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:MD
Mailing Address - Zip Code:20759-2694
Mailing Address - Country:US
Mailing Address - Phone:301-340-8339
Mailing Address - Fax:301-340-9027
Practice Address - Street 1:10313 GEORGIA AVE STE 202
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902-5006
Practice Address - Country:US
Practice Address - Phone:301-681-9101
Practice Address - Fax:301-681-3525
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2023-12-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101232298207V00000X
MDD73201207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD050966300Medicaid
MD050966300Medicaid
MD231832ZAEMedicare PIN