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NPI Code Detail

MEDICARE: SCOTT FORBES WAGNER MD

MEDICARE: SCOTT FORBES 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
1208000000XPediatrics Physician292441MA
2390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1356801237
Entity Type Code : Individual
Provider Name (Legal Business Name) : SCOTT FORBES WAGNER MD
Provider Business Mailing Address
First Line : PO BOX 415348
Second Line :
City : BOSTON
State : MA
Zip : 02241-5348
Country : US
Telephone Number : 800-225-8885
Fax Number : 508-334-1977
Provider Business Practice Location Address
First Line : 225 LEOMINSTER RD
Second Line :
City : STERLING
State : MA
Zip : 01564-2148
Country : US
Telephone Number : 978-422-6900
Fax Number : 978-422-7561
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/25/2019
Last Update Date : 01/20/2026

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