Individual
LEE-ANN MARIE WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
22 S GREENE ST, BALTIMORE, MD 21201-1544
(410) 328-2882
(410) 328-7607
Mailing address
PO BOX 64442, BALTIMORE, MD 21264-4442
(410) 328-2882
(410) 328-7607
Taxonomy
Speciality
Code
Description
License number
State
208M00000X
Hospitalist Physician
Primary
D72962
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
417787801
—
MD
01
—
975341-02 & 03
CAREFIRST BC/BS
MD
01
—
P00894783
RAILROAD MEDICARE
DC
01
—
S062-0443
CAREFIRST BC/BS REGIONAL
MD
Enumeration date
03/08/2007
Last updated
12/07/2015
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