David Wagoner, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

17453 Issued in NC

Practice address

2711 Randolph Rd
Suite 501
Charlotte, NC 28207-2027

Phone

(704) 384-8600

Fax

(704) 384-8610

NPI assigned

Apr 3, 2006

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)

Not enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1144022400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1289779200000",
    "number": "1447212907",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 60447",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282600447",
            "telephone_number": "704-384-8600",
            "fax_number": "704-384-8610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2711 RANDOLPH RD",
            "address_2": "SUITE 501",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282072027",
            "telephone_number": "704-384-8600",
            "fax_number": "704-384-8610"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGONER",
        "first_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-03",
        "last_updated": "2010-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NC",
            "license": "17453",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8985210",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Judith Rea Wagner, CRNA
• Kevin Wagner, FNP
• Kristin Elizabeth Wagner, M.D.
• Stephanie Wagner, LCSW, LISW-CP
• Theresa Renee Wagner, BCABA
• Fallon Wagoner
• Kathleen Danehy Wagoner, NCC, LPCA
• Wagstaff Welness Center
• Holly T Wahab, NP
• Carrie Sook-Yee Wai, M.A.

• Pediatrics Physician in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Pediatrics Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2010; 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.