John Harvey Wagoner, M.D., PH.D., MBA

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

D48079 Issued in MD

Practice address

133 Old Solomons Island Road
Bayshore Counseling and Psychological Services, LLC
Annapolis, MD 21401

Phone

(410) 266-9747

Fax

(410) 266-9749

NPI assigned

Dec 18, 2006

Last updated

Dec 4, 2013By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

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

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Apr 1, 2018 through Apr 1, 2028

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Business Administration, Doctor of Medicine, Doctor of Philosophy

State licenses

Practice roles

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

• Touchstones LLC

  • Clinical Social Worker
  • Annapolis, MD
  • NPI 1326325366
  NPD (past)

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

{
    "created_epoch": "1166400000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1386115200000",
    "number": "1245393529",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "133 OLD SOLOMONS ISLAND ROAD",
            "city": "ANNAPOLIS",
            "state": "MD",
            "postal_code": "21401",
            "telephone_number": "410-266-9747",
            "fax_number": "410-266-9749"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "133 OLD SOLOMONS ISLAND ROAD",
            "address_2": "BAYSHORE COUNSELING AND PSYCHOLOGICAL SERVICES, LLC",
            "city": "ANNAPOLIS",
            "state": "MD",
            "postal_code": "21401",
            "telephone_number": "410-266-9747",
            "fax_number": "410-266-9749"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGONER",
        "first_name": "JOHN",
        "middle_name": "HARVEY",
        "name_prefix": "Dr.",
        "credential": "M.D., PH.D., MBA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-18",
        "last_updated": "2013-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MD",
            "license": "03283",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MD",
            "license": "D48079",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF MD",
            "identifier": "54297601",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• James M Wagner, D.C.
• Jennah Castleman Wagner, DMD
• Matthew Phillip Wagner, M.D.
• Priya Tahiliani Wagner, M.D.
• Sarah Wagner
• Marjorie P Wagovich, PT
• Maureen Ann Wahl, LCSW-C
• Evan Walding, MBBS
• Walgreen Co (Walgreens #19249)
• Walgreen Co (Walgreens #19313)

• Psychiatry Physician in Annapolis, MD
• Providers in Annapolis, MD by specialty
• Psychiatry Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2013; 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.

Verify at the official NPI Registry.