Provider Demographics
NPI:1841399441
Name:WAGNER, STEVEN (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:
Last Name:WAGNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 ST LAWRENCE DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:TIFFIN
Mailing Address - State:OH
Mailing Address - Zip Code:44883-8310
Mailing Address - Country:US
Mailing Address - Phone:419-455-8501
Mailing Address - Fax:419-455-8504
Practice Address - Street 1:45 ST LAWRENCE DR
Practice Address - Street 2:SUITE 201
Practice Address - City:TIFFIN
Practice Address - State:OH
Practice Address - Zip Code:44883-8310
Practice Address - Country:US
Practice Address - Phone:419-455-8501
Practice Address - Fax:419-455-8504
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35037285207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0413127Medicaid
OH0470347Medicare PIN