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Individual

RONALD S WAGNER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
110 MARCUS DRIVE, MELVILLE, NY 11747
(631) 390-1793
(631) 390-1780
Mailing address
110 MARCUS DRIVE, MELVILLE, NY 11747
(631) 390-1793
(631) 390-1780

Taxonomy

Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
2056791
NY

Other

Enumeration date
10/06/2005
Last updated
09/04/2012
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