Wagner, Ida Janelle

Wagner, Ida Janelle is an individual health care provider with primary practice located at 3509 N Broad St , Philadelphia PA 19140-4105. She recently has only one registered license in Allopathic & Osteopathic Physicians / Surgery, which is considered as her primary health care specialty. Wagner, Ida Janelle can be contacted via phone (215) 707-3933.

Contact Information

Primary practice address
3509 N Broad St Philadelphia PA 19140-4105
Fax: (215) 707-2531
Website:

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Surgery 208600000X MD434346 Pennsylvania
Allopathic & Osteopathic Physicians / Surgery 208600000X 25MA11470600 New Jersey

Profile Details

NPI number 1689839177
LBN Legal business name Wagner, Ida Janelle
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 23rd, 2008
Last updated Aug 24th, 2022 - about 4 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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