Provider Demographics
NPI:1609847953
Name:FOGEL WAGNER, BARBARA (CRNA)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:FOGEL WAGNER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3112 MULLINEAUX LN
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-7104
Mailing Address - Country:US
Mailing Address - Phone:410-979-5117
Mailing Address - Fax:
Practice Address - Street 1:3112 MULLINEAUX LN
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-7104
Practice Address - Country:US
Practice Address - Phone:410-979-5117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY071076367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q12497Medicare UPIN
R2C141Medicare ID - Type Unspecified