Active NPI
Lance W. Wagner, M.D.
- Anesthesiology Physician
- Brooklyn, NY
National Provider Identifier
1720072911
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anesthesiology Physician
- License
- 186118-1
- Practice address
- 450 Clarkson Ave
Brooklyn, NY 11203-2056 - Phone
- (718) 270-3126
- Fax
- (718) 270-3797
- NPI assigned
- Sep 2, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anesthesiology Physician | 207L00000X | 186118-1 | NY | Primary |
Addresses
Primary practice location
450 Clarkson Ave
Brooklyn, NY 11203-2056
Mailing address
450 Clarkson Ave
Box 1262
Brooklyn, NY 11203-2056
Phone (718) 270-8867
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01401298 | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 186118-1 | NY | MD | Anesthesiology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1125619200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1483488000000",
"number": "1720072911",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "450 CLARKSON AVE",
"address_2": "BOX 1262",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112032056",
"telephone_number": "718-270-8867",
"fax_number": "718-270-1794"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "450 CLARKSON AVE",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112032056",
"telephone_number": "718-270-3126",
"fax_number": "718-270-3797"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGNER",
"first_name": "LANCE",
"middle_name": "W.",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-09-02",
"last_updated": "2017-01-04",
"status": "A"
},
"taxonomies": [
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "NY",
"license": "186118-1",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01401298",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Brooklyn, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.