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General NPI Number Information
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NPI Number | 1639377666
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Entity Type | Organization
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Legal Business Name | E NOBLE WAGNER DO PC
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Dates
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Enumeration Date | 07/11/2007
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Last Update Date | 07/11/2007
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Provider Practice Location Address
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Address Line | 424 CENTRAL AVE
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City | CHELTENHAM
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State | PA
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Zip | 19012-2104
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Country | US
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Telephone | 215-379-3444
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Fax | 215-663-9430
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Provider Business Mailing Address
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Address Line | 424 CENTRAL AVE
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City | CHELTENHAM
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State | PA
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Zip | 19012-2104
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Country | US
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Telephone | 125-379-3444
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Fax | 215-663-9430
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. E NOBLE WAGNER
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Credential | DO
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Telephone | 215-379-3444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State | PA
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