Individual
KATHRYN R WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
10 BELVIDERE AVE, WORCESTER, MA 01605
(952) 595-1100
(612) 294-4903
Mailing address
11995 SINGLETREE LN, STE 500, EDEN PRAIRIE, MN 55344-5347
(952) 595-1301
(612) 294-4903
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
269724
MA
2085R0202X
Diagnostic Radiology Physician
304543
LA
Other
Enumeration date
07/18/2011
Last updated
08/07/2018
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