Provider Demographics
NPI:1851322150
Name:WAGGONER, STEVEN (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:WAGGONER
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 1:24701 EUCLID AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117-1714
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11100 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1716
Practice Address - Country:US
Practice Address - Phone:216-844-3941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2020-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-081437207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000489288OtherANTHEM17
OH160057733OtherRAILROAD MEDICARE
OH364103OtherWELLCARE 29
741765OtherWELLCARE
000000221396OtherUNISON
OH7866366OtherAETNA
OH000000509188OtherANTHEM
OH741765OtherBUCKEYE 29
000000192501OtherUNISON17
OH2346152Medicaid
741765OtherBUCKEYE
000000489288OtherANTHEM17
OH000000509188OtherANTHEM
OH7866366OtherAETNA
OHWA4087282Medicare PIN
OH364103OtherWELLCARE 29