Wagner, Diana

Wagner, Diana is an individual health care provider with primary practice located at 460 Hartford Tpke Ste A , Vernon CT 06066-4847. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Internal Medicine, Allopathic & Osteopathic Physicians / Endocrinology, Diabetes & Metabolism. Allopathic & Osteopathic Physicians / Endocrinology, Diabetes & Metabolism is her primary health care specialty. Wagner, Diana can be contacted via phone (860) 896-4877.

Contact Information

Primary practice address
460 Hartford Tpke Ste A Vernon CT 06066-4847
Phone: (860) 896-4877
Fax: (860) 896-4876
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 47653 Wisconsin
Allopathic & Osteopathic Physicians / Endocrinology, Diabetes & Metabolism 207RE0101X 50129 Connecticut

Profile Details

NPI number 1790893022
LBN Legal business name Wagner, Diana
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 27th, 2006
Last updated Apr 30th, 2012 - 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1790893022 NPPES
Wisconsin MEDICAID 34678700

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