Provider Demographics
NPI:1770585762
Name:WAGLE, PRYIA J (MD)
Entity type:Individual
Prefix:DR
First Name:PRYIA
Middle Name:J
Last Name:WAGLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2106 NEW RD
Mailing Address - Street 2:C9
Mailing Address - City:LINWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08221-1046
Mailing Address - Country:US
Mailing Address - Phone:609-927-8881
Mailing Address - Fax:609-927-8832
Practice Address - Street 1:2106 NEW RD
Practice Address - Street 2:C9
Practice Address - City:LINWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08221-1046
Practice Address - Country:US
Practice Address - Phone:609-927-8881
Practice Address - Fax:609-927-8832
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMA07624500207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
071372SD5Medicare ID - Type Unspecified
H90585Medicare UPIN