Individual
DR. RICHARD LAVERNE WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
12 BENEVOLENT ST, PROVIDENCE, RI 02906-1103
(401) 952-8006
Mailing address
12 BENEVOLENT ST, PROVIDENCE, RI 02906-1103
(401) 952-8006
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
0101032864
VA
2084P0800X
Psychiatry Physician
Primary
MD06303
RI
Other
Enumeration date
08/24/2006
Last updated
07/08/2007
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