HOLLY WAGONER (NPI# 1447678230) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1447678230 |
| Entity Type | Individual |
| Full Name | HOLLY WAGONER |
| Other Name | HOLLY DOBRENEN |
| Practice Address |
100 E Penn Sq Fl 9 Philadelphia PA 19107-3377 |
| Mailing Address |
13001 E 17th Place Aurora CO 80045-2581 |
| Practice Telephone | 2674259200 |
| Practice Fax Number | 2674259299 |
| Mailing Telephone | 7207773846 |
| Enumeration Date | 2014-03-31 |
| Last Update Date | 2020-01-29 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208000000X | Pediatrics | MD465592 | PA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PA | 1035987610001 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 13001 E 17th Place, Aurora, CO 800452581 | 7207773846 |
| Street Address |
100 E PENN SQ FL 9 |
| City | PHILADELPHIA |
| State | PA |
| Zip Code | 19107-3377 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578170940 | Stephanie Quist | Pharmacist | 1 S Broad Street, Philadelphia, PA 19107 | 2020-09-29 |
| 1457968448 | Cloudline Physical Therapy LLC | Physical Therapist | 239-241 South 10th St, Philadelphia, PA 19107 | 2020-09-24 |
| 1053931303 | Wilson Wong | Pharmacist | Cvs Pharmacy #450, 3401 Walnut St, Philadelphia, PA 19107 | 2020-04-16 |
| 1326608779 | Pascal Lavergne | Neurological Surgery | 111 11th St, Thomas Jefferson University, Philadelphia, PA 19107 | 2019-06-18 |
| 1639632185 | Taylor D'amore | Orthopaedic Surgery | 925 Chest Street 5th Floor, Philadelphia, PA 19107 | 2019-04-11 |
| 1043779630 | Heather Lynn Yenser | Nurse Practitioner | 111 S. 11th St., Jefferson Vascular Center (6th Floor), Philadelphia, PA 19107 | 2019-03-14 |
| 1174093702 | Jennifer Lynn Kengeter | Psychologist | 900 Walnut Street, Suite 200, Philadelphia, PA 19107 | 2018-11-27 |
| 1649751843 | Rachel Wint | Physician Assistant | 231 N Broad St Fl 2, Philadelphia, PA 19107 | 2018-08-24 |
| 1922588623 | Hyung Bin Lee | Dentist | 315 N 12th St, Apt 803, Philadelphia, PA 19107 | 2018-08-21 |
| 1750860490 | Anastasiya Khlypnych | Physician Assistant | 111 S. 11th Street, Suite 2170, Gibbon Bldg Suite 6210, Philadelphia, PA 19107 | 2018-08-13 |
| Find all providers in zip 19107 | ||||
| Taxonomy Code | 208000000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certificatio - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861036279 | Stc Pediatrics LLC | Pediatrics | 300 E Hunting Park Ave, Philadelphia, PA 19124-6018 | 2019-10-30 |
| 1447818729 | Elizabeth Edmondston Tarr | Pediatrics | 3401 Civic Center Blvd Fl 9nw55, Philadelphia, PA 19104-4319 | 2019-06-03 |
| 1245799337 | Jerry Martin Kaplan | Pediatrics | 2421 Fairmount Ave, Philadelphia, PA 19130-2517 | 2019-03-18 |
| 1992299861 | Gayathri Prabhakar | Pediatrics | 3401 Civic Center Blvd 9nw, Rm 55, Philadelphia, PA 19104-4319 | 2018-06-14 |
| 1992298004 | Daniel Rappoport | Pediatrics | 3401 Civic Center Boulevard, 9nw, Room 55, Philadelphia, PA 19104-4399 | 2018-06-13 |
| 1376069567 | Childrens Hospital of Philadelphia | Pediatrics | 3401 Civic Center Blvd Fl 4, Philadelphia, PA 19104-4319 | 2017-08-18 |
| 1558881581 | Isabel Cristina Castillo Hernandez | Pediatrics | 4500-10, Apt 201b, Philadelphia, PA 19124 | 2017-06-21 |
| 1891225694 | Joshua Hruby Sperling | Pediatrics | 3401 Civic Center Boulevard 9nw, Room 55, The Children's Hospital of Philadelphia, Philadelphia, PA 19104-4399 | 2017-06-14 |
| 1124558911 | Salvatore Charles Rametta | Pediatrics | 3401 Civic Center Boulevard Building 9nw Room 55, Children's Hospital of Philadelphia, Philadelphia, PA 19104 | 2017-06-14 |
| 1922536952 | Alyssa Coffin | Pediatrics | 3401 Civic Center Blvd Fl 9nw, Philadelphia, PA 19104-4319 | 2017-06-03 |
| Find all providers in PHILADELPHIA | ||||
| City | PHILADELPHIA |
| Zip Code | 19107 |
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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.