Individual
DR. KATHERINE MARY WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
13201 GRANGER RD STE 2, GARFIELD HTS, OH 44125-1979
(216) 475-8844
(216) 475-3816
Mailing address
24701 EUCLID AVE, 3RD FLOOR, EUCLID, OH 44117-1714
(216) 475-8844
(216) 475-3816
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
35-096862
OH
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3149168
—
OH
Enumeration date
07/09/2008
Last updated
12/19/2011
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