Active NPI
Charles I Wagner, M.D.
- Gastroenterology Physician
- Rydal, PA
National Provider Identifier
1053353920
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Gastroenterology Physician
- License
- MD010259E
- Practice address
- 1095 Rydal Rd
Suite 100
Rydal, PA 19046-1711 - Phone
- (267) 620-1100
- Fax
- (215) 572-1279
- NPI assigned
- Jun 12, 2006
- Last updated
- Jul 13, 2026
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Gastroenterology Physician | 207RG0100X | MD010259E | PW | Primary |
Addresses
Primary practice location
1095 Rydal Rd
Suite 100
Rydal, PA 19046-1711
Mailing address
1095 Rydal Rd
Suite 100
Rydal, PA 19046-1711
Phone (267) 620-1100
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 007542510002 | Medicaid | PW | |
| 14617 | Other | PW | HEALTH PARTNERS |
| 0046041000 | Other | PA | KEYSTONE EAST |
| 0949753 | Other | PA | CIGNA |
| P406157 | Other | PA | OXFORD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD010259E | PW | MD | Gastroenterology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150070400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1053353920",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1095 RYDAL RD",
"address_2": "SUITE 100",
"city": "RYDAL",
"state": "PA",
"postal_code": "190461711",
"telephone_number": "267-620-1100",
"fax_number": "215-572-1279"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1095 RYDAL RD",
"address_2": "SUITE 100",
"city": "RYDAL",
"state": "PA",
"postal_code": "190461711",
"telephone_number": "267-620-1100",
"fax_number": "215-572-1279"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGNER",
"first_name": "CHARLES",
"middle_name": "I",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-12",
"last_updated": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "207RG0100X",
"taxonomy_group": "",
"desc": "Internal Medicine, Gastroenterology",
"state": "PW",
"license": "MD010259E",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "007542510002",
"state": "PW"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH PARTNERS",
"identifier": "14617",
"state": "PW"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "KEYSTONE EAST",
"identifier": "0046041000",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "0949753",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OXFORD",
"identifier": "P406157",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Rydal, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.