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NPI Code Detail

MEDICARE: DR. JEFFREY ALLAN WAGNER MD

MEDICARE: DR. JEFFREY ALLAN WAGNER MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialist023271CT

General Provider Information

NPI Number : 1235127044
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JEFFREY ALLAN WAGNER MD
Provider Business Mailing Address
First Line : 309 SEASIDE AVE
Second Line : SUITE 201
City : MILFORD
State : CT
Zip : 06460-4625
Country : US
Telephone Number : 203-783-1831
Fax Number :
Provider Business Practice Location Address
First Line : 300 SEASIDE AVE
Second Line :
City : MILFORD
State : CT
Zip : 06460-4603
Country : US
Telephone Number : 203-876-4178
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/06/2005
Last Update Date : 07/08/2007

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