Active NPI
Robert Clark Wagner, M.D.
- Specialist
- Arlington, VA
National Provider Identifier
1972568293
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 0101030296
- Practice address
- 1635 N George Mason Dr
Suite 140
Arlington, VA 22205-3601 - Phone
- (703) 243-7677
- Fax
- (703) 243-5416
- NPI assigned
- Apr 19, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Specialist | 174400000X | 0101030296 | VA | Primary |
Addresses
Primary practice location
1635 N George Mason Dr
Suite 140
Arlington, VA 22205-3601
Mailing address
1635 N George Mason Dr
Suite 140
Arlington, VA 22205-3601
Phone (703) 243-7677
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7393202 | Medicaid | VA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1145404800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1319673600000",
"number": "1972568293",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1635 N GEORGE MASON DR",
"address_2": "SUITE 140",
"city": "ARLINGTON",
"state": "VA",
"postal_code": "222053601",
"telephone_number": "703-243-7677",
"fax_number": "703-243-5416"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1635 N GEORGE MASON DR",
"address_2": "SUITE 140",
"city": "ARLINGTON",
"state": "VA",
"postal_code": "222053601",
"telephone_number": "703-243-7677",
"fax_number": "703-243-5416"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGNER",
"first_name": "ROBERT",
"middle_name": "CLARK",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-04-19",
"last_updated": "2011-10-27",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "VA",
"license": "0101030296",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7393202",
"state": "VA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Arlington, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.