Wagner, Audrey Susan
Wagner, Audrey Susan is an individual health care provider with primary practice located at 485 Arsenal St Internal Medicine, Watertown MA 02472-5091. She recently has only one registered license in Allopathic & Osteopathic Physicians / Internal Medicine, which is considered as her primary health care specialty. Wagner, Audrey Susan can be contacted via phone (617) 972-5200.Contact Information
Primary practice address
485 Arsenal St Internal Medicine
Watertown MA 02472-5091
Phone: (617) 972-5200
Fax: (617) 972-5512
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | 76506 | Massachusetts |
Profile Details
| NPI number | 1639127152 |
|---|---|
| LBN Legal business name | Wagner, Audrey Susan |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | May 5th, 2006 |
| Last updated | Jun 27th, 2011 - about 13 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1639127152 | NPPES |
| Massachusetts | Other | J17306 | BLUE CROSS |
| Massachusetts | Other | 0015296 | BLUE CROSS |
| Massachusetts | Other | V467 | BLUE CROSS |
| Massachusetts | Other | 076506 | BLUE CROSS |
| Massachusetts | MEDICAID | 3196241 | BLUE CROSS |
Popular Providers
-
Kasuba, Paul L.
63 Pleasant St , Watertown MA 02472-2386 -
St. Goar, Anne F
485 Arsenal St Internal Medicine, Watertown MA 02472-5091 -
Toney, Vivian
29 Pine Street , Watertown MA 02472-2163 -
Kim, Joo Y
485 Arsenal St Internal Medicine, Watertown MA 02472-5091 -
Bauer, Mark R
485 Arsenal St Internal Medicine, Watertown MA 02472-5091 -
Cutler, Andrew
521 Mount Auburn St Ste 202, Watertown MA 02472-4191 -
Wild, Wayne S
705 Mount Auburn Street Tufts Health Plan, Watertown MA 02472-1508 -
Galgano, Richard C
485 Arsenal St Internal Medicine, Watertown MA 02472-5091