DR. MARIE SUSAN WAGENER (NPI# 1104054923) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104054923 |
| Entity Type | Individual |
| Full Name | DR. MARIE SUSAN WAGENER |
| Credential | D.O. |
| Practice Address |
250 Cetronia Rd Suite 301 Allentown PA 18104-9147 |
| Practice Telephone | 6104372378 |
| Mailing Telephone | 6104372378 |
| Enumeration Date | 2009-07-01 |
| Last Update Date | 2020-08-19 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207N00000X | Dermatology | OS016478 | PA | Allopathic & Osteopathic Physicians |
| Street Address |
250 CETRONIA RD SUITE 301 |
| City | ALLENTOWN |
| State | PA |
| Zip Code | 18104-9147 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669476081 | Amir H Fayyazi | Orthopaedic Surgery | 250 Cetronia Rd, Allentown, PA 18104-9147 | 2005-06-13 |
| 1043741812 | Amy Devenuto | Physical Therapist | 250 Cetronia Rd, Suite 210, Allentown, PA 18104-9147 | 2017-03-23 |
| 1245788280 | Betsy Green | Occupational Therapist | 250 Cetronia Rd, Suite 220, Allentown, PA 18104-9147 | 2016-09-20 |
| 1154879468 | Lauren Cook | Occupational Therapist | 250 Cetronia Rd, Suite 220, Allentown, PA 18104-9147 | 2016-09-15 |
| 1578922803 | Michael Sidari | Physician Assistant | 250 Cetronia Rd, Allentown, PA 18104 | 2016-02-15 |
| 1184026874 | Steven J Rogalski | Physician Assistant | 250 Cetronia Rd, Allentown, PA 18104-9147 | 2014-09-24 |
| 1568863116 | Maryjane Spotts Cerrone | Clinical Nurse Specialist | 250 Cetronia Rd, Allentown, PA 18104-9147 | 2014-09-12 |
| 1184025447 | Christine Marie Ciaverelli | Physician Assistant | 250 Cetronia Rd, Allentown, PA 18104-9147 | 2014-09-05 |
| 1376942003 | Jonna P Trexler | Physician Assistant | 250 Cetronia Rd, Allentown, PA 18104-9147 | 2014-08-19 |
| 1740606359 | Onyedikachukwu K Momah | Physician Assistant | 250 Cetronia Rd, Allentown, PA 18104-9147 | 2014-03-07 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174134191 | The Calm Space LLC | Social Worker | 2047 Pa-309, Allentown, PA 18104 | 2020-08-13 |
| 1790333458 | Loanna T Nguyen | Nurse Practitioner | 2895 Halmilton Blvd, Suite 202, Allentown, PA 18104 | 2019-08-27 |
| 1093360513 | Meghan Paul | Pharmacist | 1727 W Liberty Street, Unit 2, Allentown, PA 18104 | 2019-08-02 |
| 1750948154 | Patricia Terreros | Counselor | 3057 College Heights Blvd Suite Ll, Allentown, PA 18104 | 2019-05-22 |
| 1023593084 | Hearvana | Clinic/Center | 2200 Wets Hamilton Street Suite 311, Allentown, PA 18104 | 2018-09-26 |
| 1700397098 | Amanda L Sellers | Psychologist | 121 N Cedar Crest Blvd Ste A, Allentown, PA 18104 | 2017-10-13 |
| 1689104457 | Craig Ryan Miller | Physical Therapist | 1651 N Cedar Crest Blvd Ste 100, Allentown, PA 18104 | 2017-06-14 |
| 1780128207 | Brandi Nicole Burns | Pediatrics | 1517 Pond Road, Allentown, PA 18104 | 2016-12-19 |
| 1750824264 | William Edward Thawley | Pharmacist | 322 N 7th St., Allentown, PA 18104 | 2016-12-01 |
| 1609222371 | Extremity Mri Inc | Radiologic Technologist | 3131 College Heights Blvd Ste 400, Allentown, PA 18104 | 2016-05-11 |
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| Taxonomy Code | 207N00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Dermatology, 2007. http://www.abderm.org/ Board certification is provided by the American Board of Dermatology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164909933 | Cdc Allentown, P.C. | Dermatology | 5354 Hamilton Blvd, Allentown, PA 18106-9775 | 2018-07-25 |
| 1205327202 | Janelle Christine Santarsiero | Dermatology | 2895 Hamilton Blvd Ste 202, Allentown, PA 18104-6172 | 2018-05-24 |
| 1548257546 | John Greg Brady | Dermatology | 798 Hausman Rd, Suite 310, Allentown, PA 18104-9108 | 2005-10-04 |
| 1174144208 | Kevin Liu | Dermatology | 1200 S Cedar Crest Blvd, Allentown, PA 18103-6202 | 2020-04-29 |
| 1710520614 | Tonya Rubin | Dermatology | 5354 Hamilton Blvd, Allentown, PA 18106-9775 | 2019-10-23 |
| 1568994143 | Marc Taylor Mitton | Dermatology | 1259 S Cedar Crest Blvd, Allentown, PA 18103 | 2017-04-01 |
| 1588028799 | Naeha Gupta | Dermatology | 1259 S Cedar Crest Blvd Ste 100, Allentown, PA 18103-6373 | 2016-04-13 |
| 1659746394 | Jeffrey Lawrence Rand | Dermatology | 1259 S Cedar Crest Blvd Ste 100, Allentown, PA 18103 | 2015-12-07 |
| 1902291164 | Claire Otteni Dorfman | Dermatology | 1259 S Cedar Crest Blvd, Suite 100, Allentown, PA 18103-6372 | 2015-04-03 |
| 1023420361 | Elise Scoggin | Dermatology | 1259 S Cedar Crest Blvd, Suite 100, Allentown, PA 18103-6372 | 2014-05-21 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.