Elaine Dudley Wagner, MD

Primary specialty

Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X

License

28869 Issued in CO

Practice address

6116 E Warren Ave
Denver, CO 80222-5703

Phone

(303) 512-0888

Fax

(305) 512-2288

NPI assigned

Mar 15, 2006

Last updated

Mar 18, 2014By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 3

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.

• Peak Pathology Consultants PC

  dba UniPath, PC

  • Anatomic Pathology & Clinical Pathology Physician
  • Denver, CO
  • NPI 1407815350

  Cytopathology

  NPD (past)

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

{
    "created_epoch": "1142380800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1395100800000",
    "number": "1306815170",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "103 CONTINENTAL PL",
            "address_2": "STE 400",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370271073",
            "telephone_number": "615-916-3200",
            "fax_number": "615-658-8389"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6116 E WARREN AVE",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802225703",
            "telephone_number": "303-512-0888",
            "fax_number": "305-512-2288"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "ELAINE",
        "middle_name": "DUDLEY",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-15",
        "last_updated": "2014-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZC0500X",
            "taxonomy_group": "",
            "desc": "Pathology, Cytopathology",
            "state": "CO",
            "license": "28869",
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "CO",
            "license": "28869",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01288695",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "641599",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "50637223",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• George Andrew Waggoner, CSFA
• Jeffrey Lynn Wagnaar, P.T.
• Alyssa Wagner, PT, DPT
• Caroline Wagner, LCSW
• Dresden Marie Wagner, CPFS, CAT, ADS
• Elisabeth A Wagner, PHD, NCC
• Emily Wagner
• Jordan Wagner, PA-C
• Julia Marie Wagner, RN
• Kathleen T Wagner, CNM

• Anatomic Pathology & Clinical Pathology Physician in Denver, CO
• Providers in Denver, CO by specialty
• Anatomic Pathology & Clinical Pathology Physician in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2014; 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.