Gregory Alan Wagoner, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

38544 Issued in MA

Practice address

729 Massachusetts Ave
Boston, MA 02118-2318

Phone

(617) 414-7779

Fax

(617) 414-7776

NPI assigned

Nov 3, 2006

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

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 and National Provider Directory roles.

• Evans Medical Foundation, Inc.

  • Internal Medicine Physician
  • Boston, MA
  • NPI 1912954124
  NPD (past)

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

{
    "created_epoch": "1162512000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1700965324",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "119 COMMONWEALTH AVE",
            "city": "CHESTNUT HILL",
            "state": "MA",
            "postal_code": "024671004",
            "telephone_number": "617-964-5754",
            "fax_number": "617-414-7776"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "729 MASSACHUSETTS AVE",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021182318",
            "telephone_number": "617-414-7779",
            "fax_number": "617-414-7776"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGONER",
        "first_name": "GREGORY",
        "middle_name": "ALAN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-03",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MA",
            "license": "38544",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lindsay Wagner, PSY.D.
• Maureen Wagner, RN
• Michael J Wagner
• Rachel Ann Wagner, AUD
• Soeren Wagner, MD
• Emily Ann Wagstaff, OTR/L
• Aboubacar Wague
• Stephanie Wahab, MD
• Anam Akbar Waheed, M.D.
• Nadia K Waheed, M.D.

• Internal Medicine Physician in Boston, MA
• Providers in Boston, MA by specialty
• Internal Medicine 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.