Andrea Joan Wagner, M.D.

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

License

54447 Issued in MA

Practice address

236 Highland Ave
Somerville, MA 02143-1495

Phone

(617) 591-4263

Fax

(617) 591-4272

NPI assigned

Dec 20, 2006

Sex

Female

Sole proprietor

Yes

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

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1166572800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1326102617",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "230 HIGHLAND AVE",
            "city": "SOMERVILLE",
            "state": "MA",
            "postal_code": "021431408",
            "telephone_number": "617-591-4263",
            "fax_number": "617-591-4272"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "236 HIGHLAND AVE",
            "city": "SOMERVILLE",
            "state": "MA",
            "postal_code": "021431495",
            "telephone_number": "617-591-4263",
            "fax_number": "617-591-4272"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "ANDREA",
        "middle_name": "JOAN",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-12-20",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "MA",
            "license": "54447",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "J04479",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jean Almanor Vital
• Kate Stacey Vital
• Rachel B Vogel, M.D.
• Lydia Volaitis
• Danielle Volmar
• Katie-Rose Radin Wagner, DDS
• Hafsa Wahid
• Nicolette M Waite, RN, BSN
• Walgreen Co
• Walgreen Co

• Physical Medicine & Rehabilitation Physician in Somerville, MA
• Providers in Somerville, MA by specialty
• Physical Medicine & Rehabilitation Physician in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.