Healthcare Provider Details

I. General information

NPI: 1124339932
Provider Name (Legal Business Name): KARI LYNN WAGNER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KARI LYNN MEERSMAN

II. Dates (important events)

Enumeration Date: 06/25/2010
Last Update Date: 11/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8901 ROCKVILLE PIKE
BETHESDA MD
20889-0001
US

IV. Provider business mailing address

13922 BAUER DR
ROCKVILLE MD
20853-2759
US

V. Phone/Fax

Practice location:
  • Phone: 301-400-2342
  • Fax:
Mailing address:
  • Phone: 240-460-5913
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberD0081469
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: