Wagner Medical PC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

WAGNER MEDICAL PC

Practice address

90 Canal St Ste 4
Boston, MA 02114-2022

Phone

(844) 843-7279

NPI assigned

Nov 7, 2025

Organization subpart

No

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

Authorized official

Name

Tanya Roach

Title

Chief Credentialing Admin Officer

Phone

(970) 329-7161

Specialties & licenses 6

Addresses

Tax ID family

Sondermind2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Wagner Medical PC

  • Clinical Social Worker
  • Toms River, NJ
  • NPI 1235951187
  NPD tax ID

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

{
    "created_epoch": "1762473600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1762473600000",
    "number": "1225908981",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1099 18TH ST STE 2350",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802021936"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "90 CANAL ST STE 4",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021142022",
            "telephone_number": "844-843-7279"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAGNER MEDICAL PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-11-07",
        "last_updated": "2025-11-07",
        "certification_date": "2025-11-07",
        "status": "A",
        "authorized_official_last_name": "ROACH",
        "authorized_official_first_name": "TANYA",
        "authorized_official_title_or_position": "CHIEF CREDENTIALING ADMIN OFFICER",
        "authorized_official_telephone_number": "970-329-7161"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Aubrey Greer Wagenseller, M.D.
• Abhijeet Waghray, MD
• Elke M Wagle
• Neil Wattson Wagle, M.D.
• Nikhil Wagle, M.D.
• Alexei Wagner, M.D.
• Andrew A Wagner, M.D.
• Andrew J Wagner, M.D.
• Benjamin Alexander Wagner, MD
• Cynthia Wise Wagner, M.S., CCC-SLP

• Clinical Social Worker in Boston, MA
• Providers in Boston, MA by specialty
• Clinical Social Worker in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2025; 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.