MEDICARE: DR. MELVIN WAGNER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	D62561	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013943950
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MELVIN WAGNER M.D.

Provider Business Mailing Address
First Line	:	338 ALEXANDER SPRING RD
Second Line	:
City	:	CARLISLE
State	:	PA
Zip	:	17015-9129
Country	:	US
Telephone Number	:	717-249-6337
Fax Number	:

Provider Business Practice Location Address
First Line	:	338 ALEXANDER SPRING RD
Second Line	:
City	:	CARLISLE
State	:	PA
Zip	:	17015-9129
Country	:	US
Telephone Number	:	717-249-6337
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2006
Last Update Date	:	05/28/2021

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