Healthcare Provider Details

I. General information

NPI: 1992781975
Provider Name (Legal Business Name): HOWARD WAGENBERG DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2005
Last Update Date: 03/07/2022
Certification Date: 03/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 HERON COVE DR
MERRIMACK NH
03054-4866
US

IV. Provider business mailing address

24 HERON COVE DR
MERRIMACK NH
03054-4866
US

V. Phone/Fax

Practice location:
  • Phone: 603-880-9177
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number157
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: