Healthcare Provider Details

I. General information

NPI: 1447327705
Provider Name (Legal Business Name): LEONARD Y. WAGNER, MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 09/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

299 CAREW ST SUITE 409
SPRINGFIELD MA
01104-2301
US

IV. Provider business mailing address

PO BOX 9135
BROOKLINE MA
02446-9135
US

V. Phone/Fax

Practice location:
  • Phone: 413-734-3476
  • Fax: 413-734-7450
Mailing address:
  • Phone: 603-893-9784
  • Fax: 603-893-8886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. LEONARD Y WAGNER
Title or Position: OWNER
Credential: MD
Phone: 413-734-3476