Provider Demographics
NPI:1407815038
Name:WAGNER, KARLA MONTGOMERY (MD)
Entity Type:Individual
Prefix:
First Name:KARLA
Middle Name:MONTGOMERY
Last Name:WAGNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KARLA
Other - Middle Name:
Other - Last Name:MONTGOMERY-WAGNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2111 LAUREL BUSH RD
Mailing Address - Street 2:SUITE H
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21015-6156
Mailing Address - Country:US
Mailing Address - Phone:410-569-3300
Mailing Address - Fax:410-515-2027
Practice Address - Street 1:2111 LAUREL BUSH RD
Practice Address - Street 2:SUITE H
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21015-6156
Practice Address - Country:US
Practice Address - Phone:410-569-3300
Practice Address - Fax:410-515-2027
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0045592208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics