Individual
CHRISTIAN T WAGNER
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
135 GOLD STAR BLVD, WORCESTER, MA 01606
(508) 853-2716
(508) 856-9025
Mailing address
630 PLANTATION ST, ATTN PHYSICIAN SERVICES WOT 12TH FLOOR, WORCESTER, MA 01605
(508) 368-5529
(508) 368-5530
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
202641
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1818742
FIRST HEALTH
—
01
—
3204235
MEDICAID WELFARE
—
05
—
3204235
—
MA
01
—
44949
FALLON COMMUNITY HEALTH P
—
01
—
7200046
CIGNA HEALTH PLAN
—
01
—
7370306
AETNA US HEALTHCARE
—
01
—
784219
MVP HEALTH CARE
—
01
—
A30514
MEDICARE B
—
01
—
AA5533
HARVARD PILGRIM HEALTHCAR
—
01
—
J21993
BLUE SHIELD INDEMNITY
—
Enumeration date
03/30/2006
Last updated
07/08/2007
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