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General NPI Number Information
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NPI Number | 1841465002
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Entity Type | Individual
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Provider Name | AUDREY KARIN WAGNER MD
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Gender | Female
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Dates
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Enumeration Date | 04/28/2008
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Last Update Date | 10/06/2016
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Provider Practice Location Address
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Address Line | 345 SAINT PAUL ST MERCY MEDICAL CENTER, 9TH FLOOR, ICU
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City | BALTIMORE
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State | MD
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Zip | 21202-2123
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Country | US
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Telephone | 410-332-9610
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Fax |
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Provider Business Mailing Address
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Address Line | 5 CHRIS ELIOT CT
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City | COCKEYSVILLE
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State | MD
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Zip | 21030-1525
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Country | US
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Telephone | 203-249-4367
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Fax |
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | D73965
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 256996
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | D73965
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License Number State | MD
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