Brent J. Wagner, M.D.

Primary specialty

SpecialistTaxonomy code 174400000X

License

MD-038170-E Issued in PA

Practice address

301 S 7TH Ave
Ste 135
West Reading, PA 19611-1442

Phone

(610) 988-8919

Fax

(610) 988-8400

NPI assigned

Jun 19, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• West Grove Clinic Company LLC

  • Family Medicine Physician
  • West Grove, PA
  • NPI 1790856078
  NPD

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

{
    "created_epoch": "1119139200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1194720748",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 S 7TH AVE",
            "address_2": "STE 135",
            "city": "WEST READING",
            "state": "PA",
            "postal_code": "196111442",
            "telephone_number": "610-988-8919",
            "fax_number": "610-988-8400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 S 7TH AVE",
            "address_2": "STE 135",
            "city": "WEST READING",
            "state": "PA",
            "postal_code": "196111442",
            "telephone_number": "610-988-8919",
            "fax_number": "610-988-8400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "BRENT",
        "middle_name": "J.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-19",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "PA",
            "license": "MD-038170-E",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01692458",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• John B Villeneuve
• Vision Innovation Centers of Pennsylvania LLC
• Ariana Vitale
• Sylvia Vogel
• Stephanie Ann Wachowicz, LPT
• Tayyab Ali Waheed, MD
• Nicole Waith, CRNA
• Brittany Walker, CRNP
• Sharon Walters
• Baoqing Wang, D.ABNM

• Specialist in West Reading, PA
• Providers in West Reading, PA by specialty
• Specialist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.