Healthcare Provider Details

I. General information

NPI: 1023574159
Provider Name (Legal Business Name): MARIE-SOLEIL WAGNER MD, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2019
Last Update Date: 02/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3175 CHEMIN DE LA COTE-STE-CATHERINE
MONTREAL QC
H3T 1C5
CA

IV. Provider business mailing address

1197 LLOYD-GEORGE
VERDUN QC
H4H 2P2
CA

V. Phone/Fax

Practice location:
  • Phone: 514-345-4706
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA-84379
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: