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1508974544
MARK W WAGNER
CHARLESTON, SC
NPI
1508974544
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
2084P0800X Psychiatry & Neurology, Psychiatry
(Licence: SC 15073)
Enumeration Date
2006-08-29
Last Update Date
2011-09-06
Business Address
MARK W WAGNER MD
171 ASHLEY AVE
CHARLESTON, SC 29425-0001
Phone number: 843-792-1414
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Mailing Address
MARK W WAGNER MD
PO BOX 751461
CHARLOTTE, NC 28275-1461
Phone number: 843-792-6200
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