Active NPI
Suzanne Wagner, MD
- Pediatrics Physician
- Greensboro, NC
National Provider Identifier
1902801079
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 29970
- Practice address
- 1046 E Wendover Ave
Greensboro, NC 27405-6712 - Phone
- (336) 272-1050
- Fax
- (336) 272-1110
- NPI assigned
- Jun 16, 2005
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 29970 | NC | Primary |
Addresses
Primary practice location
1046 E Wendover Ave
Greensboro, NC 27405-6712
Mailing address
1046 E Wendover Ave
Greensboro, NC 27405-6712
Phone (336) 272-1050
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 29970 | Other | NC | NC LICENSE |
| 7985192 | Medicaid | NC |
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)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 29970 | NC | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1118880000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678147200000",
"number": "1902801079",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1046 E WENDOVER AVE",
"city": "GREENSBORO",
"state": "NC",
"postal_code": "274056712",
"telephone_number": "336-272-1050",
"fax_number": "336-272-1110"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1046 E WENDOVER AVE",
"city": "GREENSBORO",
"state": "NC",
"postal_code": "274056712",
"telephone_number": "336-272-1050",
"fax_number": "336-272-1110"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGNER",
"first_name": "SUZANNE",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-06-16",
"last_updated": "2023-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "NC",
"license": "29970",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NC LICENSE",
"identifier": "29970",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7985192",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Greensboro, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.