Healthcare Provider Details

I. General information

NPI: 1063536282
Provider Name (Legal Business Name): PAMELA D MURPHY & MARK WAGNER PTR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 08/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

623 N 5TH ST
READING PA
19601-2201
US

IV. Provider business mailing address

623 N 5TH ST
READING PA
19601-2201
US

V. Phone/Fax

Practice location:
  • Phone: 610-374-8585
  • Fax: 610-374-2574
Mailing address:
  • Phone: 610-374-8585
  • Fax: 610-374-2574

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MARK WAGNER
Title or Position: PARTNER
Credential: D.O.
Phone: 610-374-8585