MEDICARE: WOLF KARL VON WAAGNER MD

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	208D00000X	General Practice Physician	ME170625	FL

General Provider Information

NPI Number	:	1124308580
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WOLF KARL VON WAAGNER MD

Provider Business Mailing Address
First Line	:	423 RARITAN AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10305-2345
Country	:	US
Telephone Number	:	718-755-8882
Fax Number	:

Provider Business Practice Location Address
First Line	:	2306 NORTH BLVD W STE C
Second Line	:
City	:	DAVENPORT
State	:	FL
Zip	:	33837-8976
Country	:	US
Telephone Number	:	863-547-9200
Fax Number	:	863-547-9221

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

Provider Enumeration Date	:	08/17/2011
Last Update Date	:	12/02/2025

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