Walter Wagenknecht, MD

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

0420010063 Issued in VT

Practice address

17 Belmont Ave
Brattleboro, VT 05301-7601

Phone

(800) 655-3603

NPI assigned

May 30, 2006

Last updated

Jan 30, 2009By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Northwest Radiology Associates P C

  • Diagnostic Radiology Physician
  • Saint Albans, VT
  • NPI 1265595987
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1148947200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1233273600000",
    "number": "1063469419",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 910",
            "city": "GREENFIELD",
            "state": "MA",
            "postal_code": "013020910",
            "telephone_number": "413-772-8500",
            "fax_number": "413-772-8900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17 BELMONT AVE",
            "city": "BRATTLEBORO",
            "state": "VT",
            "postal_code": "053017601",
            "telephone_number": "800-655-3603"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGENKNECHT",
        "first_name": "WALTER",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-30",
        "last_updated": "2009-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "VT",
            "license": "0420010063",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1004285",
            "state": "VT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michelle Patrice Villeneuve, MSW
• Sara N Vitale
• Barbara Elizabeth Vitalis, MA
• William Vranos, M.D.
• VT Center for the Deaf & Hoh (Austine Evaluation Center)
• Walgreen Co (Walgreens #07270)
• Walgreen Co (Walgreens #18418)
• Andrew Alasdair Walker, RPH
• Theodore Edwin Walls, M.A., LMHC, LPC
• Abigail E Warren, LICSW

• Diagnostic Radiology Physician in Brattleboro, VT
• Providers in Brattleboro, VT by specialty
• Diagnostic Radiology Physician in Vermont

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.