Individual
DR. RICHARD KENT WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
263 FARMINGTON AVENUE, FARMINGTON, CT 06030-8085
(860) 679-3387
(860) 679-1494
Mailing address
263 FARMINGTON AVENUE, FARMINGTON, CT 06030-8085
(860) 679-3387
(860) 679-1494
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
67319
CT
207VM0101X
Maternal & Fetal Medicine Physician
Primary
67319
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03079002
—
MS
01
—
160058729
RR MEDICARE
—
05
—
362343103
—
TX
05
—
3862861
—
TN
01
—
4039002
BCBS
—
01
—
861880
MEDICARE
TX
01
—
8LP486
BCBS
TX
01
—
P02351968
MEDICARE RAIL ROAD
TX
Enumeration date
06/12/2006
Last updated
05/14/2025
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