Most Relevant Information
Provider Data
| NPI Number: | 1003551854 |
| Provider Name: | MARK DEAN WAGUESPACK MD |
| Entity Type: | Individual |
| Taxonomy Code: | 390200000X |
| Specialty: | Student in an Organized Health Care Education/Training Program |
| License Number: |
Most Important Dates
| Enumeration Date: | 05/04/2022 |
| Last Updated: | 06/20/2023 |
Provider Practice Location
111 S 11TH ST DEPT OF
PHILADELPHIA
PA
191074824
Practice Location Phone/Fax
| Phone: | 2159556000 |
| Fax: |
Provider Mailing Location
111 S 11TH ST DEPT OF
PHILADELPHIA
PA
191074824
Provider Mailing Phone/Fax
| Phone: | 2159556000 |
| Fax: |