MEDICARE: MRS. JULIE M. WAGNER PA-C

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	363AM0700X	Medical Physician Assistant	MA-003071-L	PA

General Provider Information

NPI Number	:	1033393269
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JULIE M. WAGNER PA-C

Provider Business Mailing Address
First Line	:	3471 FIFTH AVENUE
Second Line	:	SUITE 1110
City	:	PITTSBURGH
State	:	PA
Zip	:	15213-3221
Country	:	US
Telephone Number	:	412-692-2478
Fax Number	:	412-692-2486

Provider Business Practice Location Address
First Line	:	3471 5TH AVENUE
Second Line	:	1110
City	:	PITTSBURGH
State	:	PA
Zip	:	15213-3221
Country	:	US
Telephone Number	:	412-692-2478
Fax Number	:	412-692-2486

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

Provider Enumeration Date	:	12/24/2007
Last Update Date	:	12/24/2007

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