MEDICARE: DR. FRED ARTHUR WAGSHUL 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	207RP1001X	Pulmonary Disease Physician	35-054353	OH
2	364SF0001X	Family Health Clinical Nurse Specialist	F09200497	OH

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	:	1336137595
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FRED ARTHUR WAGSHUL MD

Provider Business Mailing Address
First Line	:	PO BOX 636746
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45263-0001
Country	:	US
Telephone Number	:	937-859-5864
Fax Number	:	937-859-8858

Provider Business Practice Location Address
First Line	:	8371 YANKEE ST
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45458-1810
Country	:	US
Telephone Number	:	937-859-5864
Fax Number	:	937-859-8858

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

Provider Enumeration Date	:	10/12/2005
Last Update Date	:	11/10/2022

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