MEDICARE: PATRICK L WAGNER 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	208600000X	Surgery Physician	0101251305	VA
2	208600000X	Surgery Physician	MD439548	PA

General Provider Information

NPI Number	:	1811154610
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICK L WAGNER MD

Provider Business Mailing Address
First Line	:	314 E NORTH AVE
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15212-4737
Country	:	US
Telephone Number	:	412-359-3731
Fax Number	:	412-442-2323

Provider Business Practice Location Address
First Line	:	314 E NORTH AVE
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15212-4737
Country	:	US
Telephone Number	:	412-359-3731
Fax Number	:	412-442-2323

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

Provider Enumeration Date	:	05/20/2008
Last Update Date	:	11/12/2020

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