Individual
MR. CRAIG R WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO ANESTHESIOLOGIST
Contact information
Practice address
509 N BROAD ST, UNDERWOOD HOSP, WOODBURY, NJ 08096
(856) 845-5836
Mailing address
509 N BROAD ST, WOODBURY, NJ 08096-1617
(856) 845-0100
(856) 848-7023
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
—
—
207L00000X
Anesthesiology Physician
Primary
25MB05214300
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1442007
—
NJ
01
—
25MB05214300
MEDICAL LICENSE
NJ
01
—
D04881500
CDS
NJ
Enumeration date
09/14/2005
Last updated
03/07/2023
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