Individual
JOHN WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6275 E VIRGINIA BEACH BLVD, SUITE 300, NORFOLK, VA 23502-2851
(757) 461-1688
(757) 455-5865
Mailing address
6275 E VIRGINIA BEACH BLVD, SUITE 300, NORFOLK, VA 23502-2851
(757) 461-1688
(757) 455-5865
Taxonomy
Speciality
Code
Description
License number
State
204D00000X
Neuromusculoskeletal Medicine & OMM Physician
Primary
028497
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C00101
MEDICARE LEGACY GROUP
—
01
—
CC7688
RAILROAD MEDICARE GROUP#
—
Enumeration date
01/03/2006
Last updated
03/31/2008
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