IndividualActive
Philip Wagenbach, PA-C
NPI 1790797116 · Medical Physician Assistant · Bomoseen, VT
Provider details
- NPI number
- 1790797116
- Entity type
- Individual
- Primary specialty
- Medical Physician AssistantPhysician Assistants & Advanced Practice Nursing Providers
- Credential
- PA-C
- Sex
- Male
- Sole proprietor
- No
- License
- 001695 (CT)
Practice location
275 Route 30 N
Bomoseen, VT 05732-9647
Phone: (802) 468-5641
Fax: (802) 468-2923
Mailing address
700 School St
Pawtucket, RI 02860-5747
Registry dates
- Enumerated
- 2006-08-13
- Last updated
- 2015-10-05
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.