Individual
BRADFORD S. WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
50 FODEN RD STE 3, SOUTH PORTLAND, ME 04106-1718
(207) 874-1489
(207) 523-8590
Mailing address
100 GANNETT DR STE C, SOUTH PORTLAND, ME 04106-5900
(207) 347-2947
(207) 874-2317
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
MD19486
ME
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
MD19486
ME
Other
Enumeration date
05/06/2009
Last updated
03/03/2026
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