Marie Susan Wagener, D.O.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

OS016478 Issued in PA

Practice address

250 Cetronia Rd
Suite 301
Allentown, PA 18104-9147

Phone

(610) 437-2378

NPI assigned

Jul 1, 2009

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in PA, FL2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Specialty

Dermatology

Education

Philadelphia College of Osteopathic Medicine, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Group M Dermatology PAGroup PAC ID 0446534374, 5 clinicians

Aesthetic Surgery AssociatesGroup PAC ID 0547207631, 7 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy, Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mwagener@directaddress.net
• Direct secure messaging: mwagener@jupiterderm.emadirect.md

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Aesthetic Surgery Associates

  • Plastic and Reconstructive Surgery Physician
  • Allentown, PA
  • NPI 1306866611

  Dermatology

  Medicare reassignment Care Compare group NPD
• Group M Dermatology PA

  • MOHS-Micrographic Surgery Physician
  • Jupiter, FL
  • NPI 1467907105

  Dermatology

  Medicare reassignment Care Compare group NPD
• Aqua Dermatology of Florida, PA

  • Dermatology Physician
  • Palm Beach Gardens, FL
  • NPI 1538270335
  Medicare reassignment NPD
• Naples Center for Dermatology & Riverchase Dermatology

  • Durable Medical Equipment & Medical Supplies
  • Cape Coral, FL
  • NPI 1538645775
  NPD
• St. Luke'S Physician Group, Inc.

  • Plastic and Reconstructive Surgery Physician
  • Bethlehem, PA
  • NPI 1538314638
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1246406400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597795200000",
    "number": "1104054923",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 CETRONIA RD",
            "address_2": "SUITE 301",
            "city": "ALLENTOWN",
            "state": "PA",
            "postal_code": "181049147",
            "telephone_number": "610-437-2378"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 CETRONIA RD",
            "address_2": "SUITE 301",
            "city": "ALLENTOWN",
            "state": "PA",
            "postal_code": "181049147",
            "telephone_number": "610-437-2378"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGENER",
        "first_name": "MARIE",
        "middle_name": "SUSAN",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-07-01",
        "last_updated": "2020-08-19",
        "certification_date": "2020-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "PA",
            "license": "OS016478",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mwagener@directaddress.net",
            "affiliation": "N",
            "endpointDescription": "direct Message",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "XML",
            "address_1": "250 Cetronia Rd",
            "address_2": "Suite 301",
            "city": "Allentown",
            "state": "PA",
            "country_code": "US",
            "postal_code": "181049147",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Michelle Vu, D.O.
• Ryan Phung Vu
• Naga Jyothi Vulli, M.D.
• Apurva V Vyas, M.D.
• Jamie Wagaman, MA, CSOTS
• Ian Wagner
• Jamie Wagner, NP-C
• Lakeisha Wagner, LPN
• Michelle Wagner, RN
• Joel Wagstaff, D.O.

• Dermatology Physician in Allentown, PA
• Providers in Allentown, PA by specialty
• Dermatology Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2020; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.