1255438701 NPI number — HAROLD WAGNER DO PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255438701 NPI number — HAROLD WAGNER DO PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HAROLD WAGNER DO PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255438701
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/10/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7441 MARVIN D LOVE FWY
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75237-3490
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-572-1998
Provider Business Mailing Address Fax Number:
942-572-4842

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7441 MARVIN D LOVE FWY
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75237-3490
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-572-1998
Provider Business Practice Location Address Fax Number:
942-572-4842
Provider Enumeration Date:
09/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WAGNER
Authorized Official First Name:
HAROLD
Authorized Official Middle Name:
G
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
214-434-4031

Provider Taxonomy Codes

  • Taxonomy code: 207QG0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1754905 01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: DC9723 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com