Provider Demographics
NPI:1023097516
Name:WAGNER, JILL M (MD)
Entity type:Individual
Prefix:MISS
First Name:JILL
Middle Name:M
Last Name:WAGNER
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Gender:F
Credentials:MD
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Mailing Address - Street 1:1701 WESTCHESTER DR
Mailing Address - Street 2:SUITE 850
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-7008
Mailing Address - Country:US
Mailing Address - Phone:336-802-2536
Mailing Address - Fax:336-802-2534
Practice Address - Street 1:306 WESTWOOD AVE
Practice Address - Street 2:SUITE 501
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-4341
Practice Address - Country:US
Practice Address - Phone:336-802-2536
Practice Address - Fax:336-802-2534
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2012-12-07
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Provider Licenses
StateLicense IDTaxonomies
NC9501686207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8911473Medicaid
NC2256586BMedicare PIN
NC2256586AMedicare PIN
NC8911473Medicaid