Individual
DR. PETER J WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2 DUDLEY ST STE 200, PROVIDENCE, RI 02905
(401) 330-1476
Mailing address
PO BOX 1119, PROVIDENCE, RI 02901-1119
(401) 443-4150
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
253099
MA
207X00000X
Orthopaedic Surgery Physician
Primary
MD16294
RI
Other
Enumeration date
06/07/2012
Last updated
06/26/2018
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