Individual
SCOTT A WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5301 VIRGINIA WAY, 300, BRENTWOOD, TN 37027-7541
(615) 221-4474
(615) 234-3774
Mailing address
5301 VIRGINIA WAY, 300, BRENTWOOD, TN 37027-7541
(615) 221-4474
(615) 234-3774
Taxonomy
Speciality
Code
Description
License number
State
207ZF0201X
Forensic Pathology Physician
1036220
IN
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
1036220
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000487827
ANTHEM BC/BS
IN
01
—
000000587063
BLUE CROSS BLUE SHIELD
IN
05
—
100324330
—
IN
05
—
2673665
—
OH
01
—
P00685220
RAILROAD MEDICARE
IN
Enumeration date
06/20/2006
Last updated
01/09/2012
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