(800) 868-1923

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: