Provider Demographics
NPI:1699716225
Name:WAGMAN, BERNARD M (MD)
Entity type:Individual
Prefix:
First Name:BERNARD
Middle Name:M
Last Name:WAGMAN
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 1:106 IRVING ST NW STE 4800N
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20010-2927
Mailing Address - Country:US
Mailing Address - Phone:202-877-5800
Mailing Address - Fax:202-877-5885
Practice Address - Street 1:106 IRVING ST NW STE 4800N
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010
Practice Address - Country:US
Practice Address - Phone:202-877-5800
Practice Address - Fax:202-877-5885
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD12863207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CC8141OtherRAILROAD GROUP NUMBER
DC018108C29OtherINDIVIDUAL MEDICARE
DC409629OtherMEDICARE GROUP
VA6008976Medicaid
DC022468900Medicaid
MD920581100Medicaid
DC022468900Medicaid
DCCD4498Medicare PIN
P00261189Medicare PIN