Individual
HENRY W WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1 PARKLAND DR, DERRY, NH 03038-2746
(603) 421-2220
(603) 421-2223
Mailing address
1 PARKLAND DR, DERRY, NH 03038-2746
(603) 421-2220
(603) 421-2223
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
11547
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01Y003778NH02
ANTHEM
NH
05
—
2093171
—
MA
05
—
30201995
—
NH
01
—
37305
BMC HEALTHNET
—
01
—
436810
HARVARD PILGRIM
—
01
—
7770294
AETNA
—
01
—
P00209518
RAILROAD MEDICARE
—
Enumeration date
07/18/2006
Last updated
05/03/2008
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