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General NPI Number Information
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NPI Number | 1003858952
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Entity Type | Individual
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Provider Name | RICHARD KENT WAGNER MD
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Gender | Male
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Dates
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Enumeration Date | 06/12/2006
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Last Update Date | 05/14/2025
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Provider Practice Location Address
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Address Line | 263 FARMINGTON AVENUE
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City | FARMINGTON
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State | CT
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Zip | 06030-8085
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Country | US
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Telephone | 860-679-3387
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Fax | 860-679-1494
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Provider Business Mailing Address
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Address Line | 263 FARMINGTON AVENUE
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City | FARMINGTON
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State | CT
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Zip | 06030-8085
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Country | US
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Telephone | 860-679-3387
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Fax | 860-679-1494
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 67319
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 207VM0101X
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Taxonomy Name | Maternal & Fetal Medicine Physician
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License Number | 67319
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License Number State | CT
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