MEDICARE: BARBARA FOGEL WAGNER CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	071076	NY

General Provider Information

NPI Number	:	1609847953
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BARBARA FOGEL WAGNER CRNA

Provider Business Mailing Address
First Line	:	3112 MULLINEAUX LN
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21042-7104
Country	:	US
Telephone Number	:	410-979-5117
Fax Number	:

Provider Business Practice Location Address
First Line	:	3112 MULLINEAUX LN
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21042-7104
Country	:	US
Telephone Number	:	410-979-5117
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/26/2006
Last Update Date	:	07/12/2023

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