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Organization
WAGNER MEDICAL PC
Active
Organization
WAGNER MEDICAL PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TANYA ROACH (CHIEF CREDENTIALING ADMIN OFFICER)
(970) 329-7161
Entity
Organization
Contact information
Practice address
90 CANAL ST STE 4, BOSTON, MA 02114-2022
(844) 843-7279
Mailing address
1099 18TH ST STE 2350, DENVER, CO 80202-1936
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
103T00000X
Psychologist
—
—
1041C0700X
Clinical Social Worker
Primary
—
—
106H00000X
Marriage & Family Therapist
—
—
2084P0800X
Psychiatry Physician
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Enumeration date
11/07/2025
Last updated
11/07/2025
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