Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Mr. Philip Wagenbach, PA-C

Individual provider Physician Assistant · NPI 1790797116

Mr. Philip Wagenbach, PA-C is a Physician Assistant in Bomoseen, Vermont. Qualified in 2005, 21 years ago. Practices with Community Health Centers of the Rutland Region Inc, a 102-clinician group and accepts Medicare assignment. Licensed in Connecticut and Vermont.

Years since qualifying
21
Licensed in
CT, VT
In the registry since
2006
Specialties on file
2
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

See every abbreviation used in this directory →

Practice location Address checks out

275 Route 30 N
Bomoseen, VT 05732-9647
Phone: (802) 468-5641
Fax: (802) 468-2923
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Medical Physician Assistant (primary) Taxonomy 363AM0700X · Licence 055-0031268 (VT)
Physician Assistant Taxonomy 363A00000X · Licence 001695 (CT)

Record details

NPI number1790797116
Entity typeIndividual (Type 1)
GenderMale
Credentials PA-C
Sole proprietorNo
NPI enumeratedAugust 13, 2006
Last updated in NPPESOctober 5, 2015

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2005 (21 years in practice)
Group practice Community Health Centers Of The Rutland Region Inc — 102 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

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