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Organization
CIRCLE OF LIFE MD LLC
Active
Organization
CIRCLE OF LIFE MD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIRSTEN E WAGNER MD (OWNER-DIRECTOR)
(978) 468-2850
Entity
Organization
Contact information
Practice address
203 WILLOW ST BLDG B, SOUTH HAMILTON, MA 01982-2292
(978) 535-6043
(978) 535-6047
Mailing address
205 WILLOW ST BLDG B, SOUTH HAMILTON, MA 01982-2255
(978) 535-6043
(978) 535-6047
Taxonomy
Speciality
Code
Description
License number
State
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
223761
LICENSE
MA
Enumeration date
06/02/2010
Last updated
02/16/2016
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