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NPI Code Detail

MEDICARE: KYLE L WAGAMON MD

MEDICARE: KYLE L WAGAMON 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
1207N00000XDermatology Physician35083746OH
2207ND0900XDermatopathology Physician35083746OH

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3P00406585OTHEROHRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
17474933OTHEROHAETNA
2000000217451OTHEROHUNISON
4415051OTHEROHWELLCARE
5000000527821OTHEROHANTHEM
6MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7748956OTHEROHBUCKEYE

General Provider Information

NPI Number : 1780758003
Entity Type Code : Individual
Provider Name (Legal Business Name) : KYLE L WAGAMON MD
Provider Business Mailing Address
First Line : 19301 CYCLONE DR
Second Line :
City : CLEVELAND
State : OH
Zip : 44135-1731
Country : US
Telephone Number : 330-393-4000
Fax Number : 330-392-5870
Provider Business Practice Location Address
First Line : 2660 E MARKET ST
Second Line :
City : WARREN
State : OH
Zip : 44483-6204
Country : US
Telephone Number : 330-393-4000
Fax Number : 330-392-5870
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/20/2006
Last Update Date : 01/17/2014

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Directions to “ KYLE L WAGAMON MD” Practice Location

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