Provider Demographics
NPI:1689029456
Name:WAGLE, SARITA
Entity Type:Individual
Prefix:
First Name:SARITA
Middle Name:
Last Name:WAGLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 E. MARSHALL ST.
Mailing Address - Street 2:BOX 980264
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23298
Mailing Address - Country:US
Mailing Address - Phone:804-828-9955
Mailing Address - Fax:804-828-5775
Practice Address - Street 1:1250 E. MARSHALL ST.
Practice Address - Street 2:BOX 980264
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23298
Practice Address - Country:US
Practice Address - Phone:804-828-9955
Practice Address - Fax:804-828-5775
Is Sole Proprietor?:No
Enumeration Date:2016-04-29
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD92412208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics