Individual
DR. MICHAEL ROBERT WAGNER
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
620 JOHN PAUL JONES CIR, PORTSMOUTH, VA 23708-2111
(757) 953-2114
Mailing address
1337 ROCKBRIDGE AVE, NORFOLK, VA 23508-1339
(757) 489-0133
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
0101048398
VA
Other
Enumeration date
04/07/2006
Last updated
07/08/2007
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