Cliff W Wagner, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

030264 Issued in CT

Practice address

2909 Berlin Tpke
Newington, CT 06111-4115

Phone

(860) 436-3757

Fax

(860) 436-9622

NPI assigned

Apr 2, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1175472000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1400112000000",
    "number": "1407977119",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2909 BERLIN TPKE",
            "city": "NEWINGTON",
            "state": "CT",
            "postal_code": "061114115",
            "telephone_number": "860-436-3757",
            "fax_number": "860-436-9622"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2909 BERLIN TPKE",
            "city": "NEWINGTON",
            "state": "CT",
            "postal_code": "061114115",
            "telephone_number": "860-436-3757",
            "fax_number": "860-436-9622"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "CLIFF",
        "middle_name": "W",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-02",
        "last_updated": "2014-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CT",
            "license": "030264",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CT",
            "license": "030264",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shana Virtudes
• Bradley Adam Visconti, D.C
• Visual Perceptions Eyecare
• Tuanh Thi Vo
• Michael Vukelic
• Melanie Wagner, M.A., CCC-SLP
• Wal-Mart Stores East LP
• Wal-Mart Stores East, LP
• Walgreen Co
• Walgreen Co

• Family Medicine Physician in Newington, CT
• Providers in Newington, CT by specialty
• Family Medicine Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2014; 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.