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Individual

ANDREW A WAGNER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
RABB 440, BETH ISRAEL DEACONESS MEDICAL CENTER, BOSTON, MA 02215-0000
(617) 667-2898
(617) 667-2897
Mailing address
330 BROOKLINE AVENUE, RABB 440, BOSTON, MA 02215
(617) 667-2898
(617) 667-2897

Taxonomy

Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
227569
MA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
2117401
MA
Enumeration date
05/30/2006
Last updated
12/07/2009
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