Provider Demographics
NPI:1124308580
Name:VON WAAGNER, WOLF KARL (MD)
Entity type:Individual
Prefix:
First Name:WOLF
Middle Name:KARL
Last Name:VON WAAGNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:423 RARITAN AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-2345
Mailing Address - Country:US
Mailing Address - Phone:718-755-8882
Mailing Address - Fax:
Practice Address - Street 1:2306 NORTH BLVD W STE C
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33837-8976
Practice Address - Country:US
Practice Address - Phone:863-547-9200
Practice Address - Fax:863-547-9221
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-17
Last Update Date:2025-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME170625208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice