Wagamon, Kyle L
Wagamon, Kyle L is an individual health care provider with primary practice located at 2660 E Market St , Warren OH 44483-6204. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Dermatology, Allopathic & Osteopathic Physicians / Dermatopathology. Allopathic & Osteopathic Physicians / Dermatopathology is his primary health care specialty. Wagamon, Kyle L can be contacted via phone (330) 393-4000.Contact Information
Primary practice address
2660 E Market St
Warren OH 44483-6204
Phone: (330) 393-4000
Fax: (330) 392-5870
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Dermatology | 207N00000X | 35083746 | Ohio |
| Allopathic & Osteopathic Physicians / Dermatopathology | 207ND0900X | 35083746 | Ohio |
Profile Details
| NPI number | 1780758003 |
|---|---|
| LBN Legal business name | Wagamon, Kyle L |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Nov 20th, 2006 |
| Last updated | Jan 17th, 2014 - about 11 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1780758003 | NPPES |
| Ohio | Other | 7474933 | AETNA |
| Ohio | Other | 000000217451 | AETNA |
| Ohio | Other | P00406585 | AETNA |
| Ohio | Other | 415051 | AETNA |
| Ohio | Other | 000000527821 | AETNA |
| Ohio | MEDICAID | 2754827 | AETNA |
| Ohio | Other | 748956 | AETNA |
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