Individual
ANDREA JOAN WAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
236 HIGHLAND AVE, SOMERVILLE, MA 02143-1495
(617) 591-4263
(617) 591-4272
Mailing address
230 HIGHLAND AVE, SOMERVILLE, MA 02143-1408
(617) 591-4263
(617) 591-4272
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
54447
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
J04479
BLUE CROSS BLUE SHIELD
MA
Enumeration date
12/20/2006
Last updated
07/08/2007
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