Individual
WALTER WAGENKNECHT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
17 BELMONT AVE, BRATTLEBORO, VT 05301-7601
(800) 655-3603
Mailing address
PO BOX 910, GREENFIELD, MA 01302-0910
(413) 772-8500
(413) 772-8900
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
0420010063
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1004285
—
VT
Enumeration date
05/30/2006
Last updated
01/30/2009
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