MEDICARE: MISS ANNETTE VERONICA WAGNER M.D.

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
1	207V00000X	Obstetrics & Gynecology Physician	238373	NY
2	207V00000X	Obstetrics & Gynecology Physician	MD440690	PA
3	207V00000X	Obstetrics & Gynecology Physician	44148	CT

General Provider Information

NPI Number	:	1699718031
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS ANNETTE VERONICA WAGNER M.D.

Provider Business Mailing Address
First Line	:	100 N ACADEMY AVE
Second Line	:
City	:	DANVILLE
State	:	PA
Zip	:	17822-4903
Country	:	US
Telephone Number	:	570-808-7916
Fax Number	:	570-808-6006

Provider Business Practice Location Address
First Line	:	1155 EAST MTN BLVD
Second Line	:
City	:	WILKES BARRE
State	:	PA
Zip	:	18702-7906
Country	:	US
Telephone Number	:	570-808-7916
Fax Number	:	570-808-6006

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2006
Last Update Date	:	02/03/2026

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