Individual
DR. TRACI LEE WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
580 ST. JOHNSBURY RD., LITTLETON, NH 03561
(603) 444-7070
(603) 788-5027
Mailing address
133 PLEASANT ST, BERLIN, NH 03570-2006
(603) 752-2040
(603) 752-3862
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
12859
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1011825
—
VT
05
—
30205431
—
NH
Enumeration date
01/05/2006
Last updated
04/11/2017
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