Wagner, Matthew George

Wagner, Matthew George is an sole proprietor health care provider with primary practice located at 11116 Medical Campus Rd Suite 2989, Hagerstown MD 21742-6710. He recently has only one registered license in Allopathic & Osteopathic Physicians / Psychiatry, which is considered as his primary health care specialty. Wagner, Matthew George can be contacted via phone (301) 766-7600.

Contact Information

Primary practice address
11116 Medical Campus Rd Suite 2989 Hagerstown MD 21742-6710
Phone: (301) 766-7600
Fax: (301) 797-4976
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Psychiatry 2084P0800X D0034015 Maryland

Profile Details

NPI number 1689609133
LBN Legal business name Wagner, Matthew George
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jul 12th, 2006
Last updated Mar 13th, 2012 - about 13 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 1689609133 NPPES
Maryland Other 425459-02 BC/BS ID #
Maryland Other 001240825 0004 BC/BS ID #
Maryland Other PVPB125341 BC/BS ID #
Maryland MEDICAID 5324319 00 BC/BS ID #

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