THEODORE T WAGNER (NPI# 1831162791) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1831162791 |
| Entity Type | Individual |
| Full Name | THEODORE T WAGNER |
| Credential | MD |
| Practice Address |
2512 E Dupont Rd Ste. 100 Fort Wayne IN 46825-1675 |
| Mailing Address |
3702 New Vision Dr Bldg B Fort Wayne IN 46845-1703 |
| Practice Telephone | 2604366667 |
| Practice Fax Number | 2604697437 |
| Mailing Telephone | 2602666013 |
| Enumeration Date | 2006-02-10 |
| Last Update Date | 2020-06-25 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208800000X | Urology | 01050471A | IN | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OH | 0748972 | 05 | |
| IN | ANTHEM BC/BS | 000000087512 | 01 |
| IN | 200245650 | 05 | |
| OH | 2568556 | 05 | |
| IN | 100081380 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811077894 | Theodore A Wagner | Orthopaedic Surgery | Uwmc-roosevelt, 4245 Roosevelt Way Ne, Seattle, WA 98105-4740 | 2006-10-16 |
| Street Address |
2512 E DUPONT RD STE. 100 |
| City | FORT WAYNE |
| State | IN |
| Zip Code | 46825-1675 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891795852 | Mark Daniel Dabagia | Urology | 2512 E Dupont Rd, Suite 100, Fort Wayne, IN 46825-1609 | 2005-07-29 |
| 1790021814 | Dawn M. Labarbera | Physician Assistant | 2512 E Dupont Rd, Suite 210, Fort Wayne, IN 46825-1609 | 2012-12-18 |
| 1851640155 | Sarah E Slocum | Registered Nurse | 2512 E Dupont Rd, Ste 100, Fort Wayne, IN 46825-1609 | 2012-08-31 |
| 1871808923 | Fort Wayne Orthopaedics, LLC | Orthopaedic Surgery | 2512 E Dupont Rd, Suite 110, Fort Wayne, IN 46825-1609 | 2010-08-13 |
| 1477864239 | Sarah Anne Brady | Nurse Practitioner | 2512 E Dupont Rd, Suite 100, Fort Wayne, IN 46825-1609 | 2010-06-27 |
| 1275770802 | Sara L Speith | Registered Nurse | 2512 E Dupont Rd, Suite 200, Fort Wayne, IN 46825-1609 | 2009-01-20 |
| 1972638955 | Northeast Indiana Urology, P.C. | Durable Medical Equipment & Medical Supplies | 2512 E Dupont Rd, Suite 100, Fort Wayne, IN 46825-1609 | 2007-02-22 |
| 1841222452 | George L Martin | Urology | 2512 E Dupont Rd, Ste 100, Fort Wayne, IN 46825-1609 | 2006-07-06 |
| 1619920295 | Northeast Indiana Urology, PC | Urology | 2512 E Dupont Rd, Suite 100, Fort Wayne, IN 46825-1609 | 2006-05-18 |
| 1417908526 | Tracy E Mullins | Nurse Practitioner | 2512 E Dupont Rd, Suite 100, Fort Wayne, IN 46825-1675 | 2006-05-13 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336772078 | Bradley Murphy | Occupational Therapist | 2626 St Joe Center Ed, Fort Wayne, IN 46825 | 2020-02-21 |
| 1144851015 | Sabryna Roman | Developmental Therapist | 2626 St Joe Center Rd, Fort Wayne, IN 46825 | 2020-01-30 |
| 1205474103 | Ashleigh Miller | Developmental Therapist | 2626 St. Joe Center Rd, Fort Wayne, IN 46825 | 2019-12-11 |
| 1962055152 | Carehalo Ohio LLC | General Practice | 2510 Dupont Circle Dr., Suite 201, Fort Wayne, IN 46825 | 2019-07-17 |
| 1306318175 | Logan Alan Williams | Nurse Anesthetist, Certified Registered | 10315 Dawsons Creek Blvd Ste B, Fort Wayne, IN 46825 | 2018-12-18 |
| 1326582925 | Mark F Stoner LLC | Dentist | 9830 Auburn Rd Suite 102, Fort Wayne, IN 46825 | 2016-12-15 |
| 1336695782 | Nadine Rene' Handy | Nurse Practitioner | 3978 New Vision Dr., Fort Wayne, IN 46825 | 2016-08-26 |
| 1558815712 | Nathan Paul Miller | Physical Therapist | 10006 Auburn Park Dr, Fort Wayne, IN 46825 | 2016-08-05 |
| 1013366905 | Brianna Abbott | Physician Assistant | 1234 E Dupont Rd Ste 7, Fort Wayne, IN 46825 | 2016-06-10 |
| 1003276643 | Seiss, LLC | Psychologist | 9910 Dupont Circle Drive, Suite 140, Fort Wayne, IN 46825 | 2016-02-24 |
| Find all providers in zip 46825 | ||||
| Taxonomy Code | 208800000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Urology |
| A urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Urology, 2007. http://www.abu.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Urology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225287998 | George W. Bowers | Urology | 12002 Haddington Court, Fort Wayne, IN 46814 | 2008-09-17 |
| 1437116530 | Adam Craig Thomas | Urology | 2512 E. Dupont Road, Suite 100, Fort Wayne, IN 46825 | 2006-05-01 |
| 1578532479 | David S Turk | Urology | 11141 Parkview Plaza Dr Ste 320, Fort Wayne, IN 46845-1714 | 2006-03-15 |
| 1891795852 | Mark Daniel Dabagia | Urology | 2512 E Dupont Rd, Suite 100, Fort Wayne, IN 46825-1609 | 2005-07-29 |
| 1962637652 | Christopher B King | Urology | 2512 E Dupont Rd Ste 100, Fort Wayne, IN 46825-1609 | 2009-05-25 |
| 1518133792 | Altin Miraka | Urology | 11141 Parkview Plaza Dr Ste 320, Fort Wayne, IN 46845-1714 | 2008-05-07 |
| 1508945809 | Fort Wayne Urology Inc. | Urology | 1818 Carew St, Suite 210, Fort Wayne, IN 46805-4788 | 2006-11-06 |
| 1598776668 | Scott L. Palmer | Urology | 11108 Parkview Circle Dr, Fort Wayne, IN 46845-1730 | 2006-08-11 |
| 1457362717 | Rhys Rudolph | Urology | 1818 Carew St, Suite 210, Fort Wayne, IN 46805-4788 | 2006-08-11 |
| 1831100015 | Satish Velagapudi | Urology | 1818 Carew St, Suite 210, Fort Wayne, IN 46805-4788 | 2006-08-11 |
| Find all providers in FORT WAYNE | ||||
| City | FORT WAYNE |
| Zip Code | 46825 |
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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.