Individual provider · NPI-1

Dr. Cliff W Wagner, MD

Family Medicine · Newington, CT

NPI number1407977119
StatusActive
Last updated in NPPESMay 15, 2014

Details

NPI
1407977119
Entity type
Individual (NPI-1)
Name
Dr. Cliff W Wagner
Credential
MD
Sex
Male
Sole proprietor
No
Enumeration date
Apr 2, 2007
Last updated
May 15, 2014

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207Q00000X Family Medicine030264CTYes
207P00000X Emergency Medicine030264CT

Practice location

2909 Berlin Tpke
Newington, CT 06111-4115

Phone 860-436-3757 · Fax 860-436-9622

Mailing address

2909 Berlin Tpke
Newington, CT 06111-4115

Phone 860-436-3757 · Fax 860-436-9622

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