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Contact Information

GARY L WAGONER, MD P A
925 BISHOP WALSH RD
SUITE 4
CUMBERLAND, MD21502
 Phone: 301-777-5326
 Fax: 301-777-0325
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Family Medicine

207Q00000X 08 Physician/Family Practice
Indicates primary specialty

NPI Profile & details for GARY L WAGONER · (Male)

NPI Number 1225034853
Status Active
Credentials MD P A
Entity Individual
Enumeration date 06/28/2005
Last updated 09/18/2018 - About 8 years ago
Sole proprietor 1 Yes
Identifiers
  • MD License # D0022181
  • MD Medicaid 189121900
  • MD Other P11723 BLUE SHIELD POS
  • MD Other 8814GL CAREFIRST BS
  • MD Other 104012109 CIGNA
  • MD Other W0230001 FEDERAL BS
  • MD Other 408113495 R.R. MEDICARE
  • MD Other 218706 UNITED HEALTH CARE
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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