| Doctor Name: | DAVID GORDON WAGNER |
| NPI Number: | 1326046897 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | D0051588 |
| Business Practice Address: | 14955 Shady Grove Rd Suite 125 Rockville, MD - 208508700 |
| Business Phone Number: | 3017651816 |
| Business Fax Number: | 3018389712 |
| Mailing Address: | 14955 Shady Grove Rd, Suite 125 ROCKVILLE |
| State: | MD |
| Postal Code: | 208508700 |
| Phone Number: | 3017651816 |
| Fax Number: | 3018389712 |
| NPI Enumeration Date: | 07/08/2005 |
| NPI Last Update Date: | 10/13/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174400000X |
| License Number: | D0051588 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MD |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |