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NPI Code Detail

MEDICARE: DR. ANJA WAGNER MD

MEDICARE: DR. ANJA WAGNER MD
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
1207RC0000XCardiovascular Disease Physician050151CT

General Provider Information

NPI Number : 1699909432
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ANJA WAGNER MD
Provider Business Mailing Address
First Line : 2660 MAIN ST
Second Line : STE 216
City : BRIDGEPORT
State : CT
Zip : 06606-5301
Country : US
Telephone Number : 203-696-3495
Fax Number : 203-581-6509
Provider Business Practice Location Address
First Line : 2979 MAIN ST
Second Line :
City : BRIDGEPORT
State : CT
Zip : 06606-4284
Country : US
Telephone Number : 203-683-5100
Fax Number : 203-683-5140
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/07/2009
Last Update Date : 10/10/2017

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