Active NPI
Charlotte Bowen Wagamon, M.D.
- Internal Medicine Physician
- Meadville, PA
National Provider Identifier
1154397693
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- MD044011L
- Practice address
- 15957 Conneaut Lake Road Suite 3
Meadville, PA 16335 - Phone
- (440) 858-3175
- Fax
- (814) 724-5295
- NPI assigned
- Feb 24, 2006
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | MD044011L | PA | Primary |
Addresses
Primary practice location
15957 Conneaut Lake Road Suite 3
Meadville, PA 16335
Mailing address
15957 Conneaut Lake Road Suite 3
Meadville, PA 16335
Phone (440) 858-3175
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: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Oct 3, 2015 through Oct 3, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD044011L | PA | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1140739200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1551744000000",
"number": "1154397693",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15957 CONNEAUT LAKE ROAD SUITE 3",
"city": "MEADVILLE",
"state": "PA",
"postal_code": "16335",
"telephone_number": "440-858-3175",
"fax_number": "814-724-5295"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15957 CONNEAUT LAKE ROAD SUITE 3",
"city": "MEADVILLE",
"state": "PA",
"postal_code": "16335",
"telephone_number": "440-858-3175",
"fax_number": "814-724-5295"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGAMON",
"first_name": "CHARLOTTE",
"middle_name": "BOWEN",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-02-24",
"last_updated": "2019-03-05",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "PA",
"license": "MD044011L",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Meadville, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2019; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.