Provider Demographics
NPI:1861569501
Name:WAGLE, MANISHA (MD)
Entity type:Individual
Prefix:DR
First Name:MANISHA
Middle Name:
Last Name:WAGLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:DUMAS
Mailing Address - State:TX
Mailing Address - Zip Code:79029-3808
Mailing Address - Country:US
Mailing Address - Phone:806-934-7839
Mailing Address - Fax:806-394-7836
Practice Address - Street 1:224 E 2ND ST
Practice Address - Street 2:
Practice Address - City:DUMAS
Practice Address - State:TX
Practice Address - Zip Code:79029-3808
Practice Address - Country:US
Practice Address - Phone:806-934-7839
Practice Address - Fax:806-394-7836
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1124207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX855450OtherBCBS GROUP NUMBER
TX00697YMedicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
TX8E0357Medicare UPIN
TXP00289493Medicare ID - Type UnspecifiedRAILROAD GROUP NUMBER