Individual provider · Type 1 NPI

Philip Wagenbach, PA-C

Medical Physician Assistant · Bomoseen, VT

NPI number 1790797116 Active

Practice location

275 Route 30 N
Bomoseen, VT 05732-9647

Call (802) 468-5641 Map

Fax (802) 468-2923

Mailing address

700 School St
Pawtucket, RI 02860-5747

Specialties and licenses

TaxonomyCodeLicense
Physician Assistant 363A00000X001695 (CT)
Medical Physician Assistant Primary 363AM0700X055-0031268 (VT)

Medical Physician Assistant: Definition to come...

35 other providers at this address

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About NPI 1790797116

Philip Wagenbach, PA-C's National Provider Identifier is 1790797116, issued on Aug 13, 2006. The primary taxonomy on file is Medical Physician Assistant (363AM0700X), and the practice location is in Bomoseen, VT. The record was last updated on Oct 5, 2015.