Jesse Wagner, M.D.
Internal Medicine in Middletown, CT. Individual provider (NPI-1).
NPI number1528048428
StatusActive
Last updated in NPPESNov 11, 2009
Details
- NPI
- 1528048428
- Entity type
- Individual (NPI-1)
- Name
- Jesse Wagner
- Credential
- M.D.
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Jan 18, 2006
- Last updated
- Nov 11, 2009
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207R00000X | Internal Medicine | 036836 | CT | Yes |
| 208M00000X | Hospitalist | 036836 | CT |
Practice location
28 Crescent StMiddletown, CT 06457-3654
Phone 860-358-4720 · Fax 860-358-6271
Mailing address
28 Crescent StMiddletown, CT 06457-3654
Phone 860-358-4720 · Fax 860-344-6271
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