Wagner, Chad Martin

Wagner, Chad Martin is an individual health care provider with primary practice located at 333 E Campus Mall Rm 5131 , Madison WI 53715-1365. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Family Medicine, Allopathic & Osteopathic Physicians / Sports Medicine. Allopathic & Osteopathic Physicians / Sports Medicine is his primary health care specialty. Wagner, Chad Martin can be contacted via phone (608) 265-4904.

Contact Information

Primary practice address
333 E Campus Mall Rm 5131 Madison WI 53715-1365
Phone: (608) 265-4904
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 200700438 North Carolina
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 77387-20 Wisconsin
Allopathic & Osteopathic Physicians / Sports Medicine 207QS0010X 064986 Georgia
Allopathic & Osteopathic Physicians / Sports Medicine 207QS0010X 77387-20 Wisconsin

Profile Details

NPI number 1568599173
LBN Legal business name Wagner, Chad Martin
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 28th, 2007
Last updated Sep 12th, 2023 - about 3 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1568599173 NPPES
Georgia MEDICAID 128548427B
Georgia MEDICAID 128548427D
Georgia MEDICAID 128548427A
Georgia MEDICAID 128548427C

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