Provider Demographics
NPI:1952180069
Name:WAGNER, JULIA ALEXANDRA (PA-C)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:ALEXANDRA
Last Name:WAGNER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2787 HIGHLAND RD
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:PA
Mailing Address - Zip Code:16148-2883
Mailing Address - Country:US
Mailing Address - Phone:814-969-4391
Mailing Address - Fax:
Practice Address - Street 1:2395 GARDEN WAY
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:PA
Practice Address - Zip Code:16148-5209
Practice Address - Country:US
Practice Address - Phone:724-426-0853
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-27
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1216008208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology