Individual
AUDREY SUSAN WAGNER
Active
Individual
AUDREY SUSAN WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
76506
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0015296
NEIGHBORHOOD HEALTH
MA
01
—
076506
TUFTS
MA
05
—
3196241
—
MA
01
—
J17306
BLUE CROSS
MA
01
—
V467
HARVARD PILGRIM
MA
Enumeration date
05/05/2006
Last updated
06/27/2011
Update your record
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