Individual
SUZANNE WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1046 E WENDOVER AVE, GREENSBORO, NC 27405-6712
(336) 272-1050
(336) 272-1110
Mailing address
1046 E WENDOVER AVE, GREENSBORO, NC 27405-6712
(336) 272-1050
(336) 272-1110
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
29970
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
29970
NC LICENSE
NC
05
—
7985192
—
NC
Enumeration date
06/16/2005
Last updated
03/07/2023
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