Provider Demographics
NPI:1467347880
Name:WAGNER, CHARLES RICHARD (MS)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:RICHARD
Last Name:WAGNER
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:764 PA-113
Mailing Address - Street 2:HILLTOWN PLAZA SHOPPING CENTER
Mailing Address - City:SOUDERTON
Mailing Address - State:PA
Mailing Address - Zip Code:18964
Mailing Address - Country:US
Mailing Address - Phone:267-477-1446
Mailing Address - Fax:
Practice Address - Street 1:1811 BETHLEHEM PIKE
Practice Address - Street 2:THE FLOURTOWN COMMONS
Practice Address - City:FLOURTWON
Practice Address - State:PA
Practice Address - Zip Code:19031
Practice Address - Country:US
Practice Address - Phone:267-477-1446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-09
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAF03691237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter