Edward S. Wagner (NPI# 1568435741, PAC ID# 6305748229) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is OBSTETRICS/GYNECOLOGY.
| Nation Provider ID (NPI) | 1568435741 |
| PAC ID by PECOS | 6305748229 |
| Professional Enrollment ID | I20040122000229 |
| Full Name | Edward S. Wagner |
| Organization Legal Name | VITALMD GROUP HOLDING LLC |
| Address |
4330 Sheridan St Suite 101 Hollywood FL 33021-1408 |
| Phone Number | 9549629802 |
| Gender | M |
| Credential | MD |
| Medical School | UNIVERSITY OF MIAMI SCHOOL OF MEDICINE |
| Graduation Year | 1991 |
| Primary Specialty | OBSTETRICS/GYNECOLOGY |
| Group Practice PAC ID | 8921091786 |
| Number of Group Practice Members | 387 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 100038 | MEMORIAL REGIONAL HOSPITAL |
| Address | Phone | Organization |
|---|---|---|
| 4330 Sheridan St, Suite 101, Hollywood, FL 33021-1408 | 9549629802 | VITALMD GROUP HOLDING LLC |
| 3225 Aviation Ave, Suite 700, Miami, FL 33133-4741 | 3052734641 | VITALMD GROUP HOLDING LLC |
| Organization Legal Name | VITALMD GROUP HOLDING LLC |
| Physicians | 416 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Tionnei A Knight | Nurse Practitioner | Vitalmd Group Holding LLC | 2964 N State Rd 7, 320 Fern Taisenchoy Bent Md LLC, Margate, FL 33063-5715 |
| Marcela J Torres | Obstetrics/gynecology | Vitalmd Group Holding LLC | 4100 Hollywood Blvd, Suite 2, Hollywood, FL 33021-6778 |
| Stacey L Mckinnon | Nurse Practitioner | Vitalmd Group Holding LLC | 769 N Clyde Morris Blvd, Ob Gyn Health Center of Volusia LLC, Daytona Beach, FL 32114-1493 |
| Timothy P Wu | Dermatology | Vitalmd Group Holding LLC | 4060 Sheridan St, Suite C, Hollywood, FL 33021-3559 |
| Victoria L Bedell | Obstetrics/gynecology | Vitalmd Group Holding LLC | 8900 Sw 117th Ave, 207b Janet Gersten Md LLC, Miami, FL 33186-2155 |
| Masha Sachenko | Obstetrics/gynecology | Vitalmd Group Holding LLC | 6853 Sw 18th St, Suite 301, Boca Raton, FL 33433-7056 |
| Sandra L Aponte | Pathology | Vitalmd Group Holding LLC | 2931 Coral Way, Medipath Pathology Services, Miami, FL 33145-3201 |
| Whitney E Shoemaker | Orthopedic Surgery | Vitalmd Group Holding LLC | 598 Sterthaus Dr, Ormond Beach, FL 32174-5128 |
| Ran Huo | Dermatology | Vitalmd Group Holding LLC | 14932 Pines Blvd, Pembroke Pines, FL 33027-1213 |
| Paola A Bordoni | Obstetrics/gynecology | Vitalmd Group Holding LLC | 9595 N Kendall Dr, 103 Ob and Gyn Associates of Kendall LLC, Miami, FL 33176-1990 |
| Street Address |
4330 SHERIDAN ST SUITE 101 |
| City | HOLLYWOOD |
| State | FL |
| Zip | 33021-1408 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Jeffrey E Caplan | Plastic and Reconstructive Surgery | 4330 Sheridan St, Suite 102, Hollywood, FL 33021-1406 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Dorrett Codner | Nurse Practitioner | South Broward Hospital District | 1150 N 35th St, Suite 205a, Hollywood, FL 33021 |
| Carmen Herrera | Nurse Practitioner | South Broward Hospital District | 3400 N 29th Ave, Hollywood, FL 33021-1002 |
| Sathi Ghosh | Psychiatry | South Broward Hospital District | 3400 N 29th Ave, Hollywood, FL 33021-1002 |
| Alan S Lane | Ophthalmology | 4000 Hollywood Blvd, 180n, Hollywood, FL 33021-1204 | |
| Ravikanth Chiravuri | Cardiovascular Disease (cardiology) | 5700 Stirling Rd, Suite 100, Hollywood, FL 33021-1522 | |
| Thomas D Rawson | Physician Assistant | Frank C Alario Md Pl | 5700 Stirling Rd, Suite 100, Hollywood, FL 33021-1522 |
| Michael L Newman | Optometry | 5700 Stirling Rd, Hollywood, FL 33021-1522 | |
| Blaine S Cameron | Anesthesiology | 5700 Stirling Rd, Hollywood, FL 33021-1522 | |
| Russell T Elba | Chiropractic | 5810 Stirling Rd, Hollywood, FL 33021-1527 | |
| Megan K Mckeon | Clinical Social Worker | Theracounsel, Inc. | 5770 Stirling Rd, Hollywood, FL 33021-1549 |
| Find all physicians in zip 33021 | |||
| City | HOLLYWOOD |
| Zip Code | 33021 |
| Specialty | OBSTETRICS/GYNECOLOGY |
| City + Specialty | HOLLYWOOD + OBSTETRICS/GYNECOLOGY |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.