Organization
CONNECTICUT FOOT SPECIALISTS, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRIAN K WAGNER D.P.M. (OWNER)
(860) 653-4708
Entity
Organization
Contact information
Practice address
43 WOODLAND ST, SUITE 210, HARTFORD, CT 06105-2363
(260) 251-7200
Mailing address
43 WOODLAND ST, SUITE 210, HARTFORD, CT 06105-2363
(860) 251-7200
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
CT000793
CT
213ES0131X
Foot Surgery Podiatrist
CT000793
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1093743502
DR. WAGNER'S NPI
CT
01
—
CT000793
DR. WAGNER'S STATE LICENSE
CT
Enumeration date
05/11/2010
Last updated
06/04/2010
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