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General NPI Number Information
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NPI Number | 1134488687
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Entity Type | Individual
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Provider Name | JOHN WAGDY FAM M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/03/2012
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Last Update Date | 02/03/2021
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Provider Practice Location Address
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Address Line | 1220 BROADCASTING RD STE 100
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City | WYOMISSING
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State | PA
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Zip | 19610-3221
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Country | US
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Telephone | 484-628-5673
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Fax |
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Provider Business Mailing Address
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Address Line | 1220 BROADCASTING RD STE 100
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City | WYOMISSING
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State | PA
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Zip | 19610-3221
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Country | US
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Telephone | 484-628-5673
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | MD460652
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License Number State | PA
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