Traci Lee Wagner, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

12859 Issued in NH

Practice address

580 St. Johnsbury Rd.
Littleton, NH 03561

Phone

(603) 444-7070

Fax

(603) 788-5027

NPI assigned

Jan 5, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in NH

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

Practice roles

Locations

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.

• Littleton Hospital Association

  • Critical Access Hospital
  • Littleton, NH
  • NPI 1144223702
  Medicare reassignment NPD
• Littleton Hospital Association

  • Durable Medical Equipment & Medical Supplies
  • Littleton, NH
  • NPI 1174398846
  NPD
• Littleton Hospital Association

  • Rural Health Clinic/Center
  • Littleton, NH
  • NPI 1811944523
  NPD (past)

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

{
    "created_epoch": "1136419200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1491868800000",
    "number": "1932187465",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "133 PLEASANT ST",
            "city": "BERLIN",
            "state": "NH",
            "postal_code": "035702006",
            "telephone_number": "603-752-2040",
            "fax_number": "603-752-3862"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "580 ST. JOHNSBURY RD.",
            "city": "LITTLETON",
            "state": "NH",
            "postal_code": "03561",
            "telephone_number": "603-444-7070",
            "fax_number": "603-788-5027"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "TRACI",
        "middle_name": "LEE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-05",
        "last_updated": "2017-04-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NH",
            "license": "12859",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30205431",
            "state": "NH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1011825",
            "state": "VT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Norman Eric Vanleuven, MD
• Lacy Veilleux
• Jennifer Wackerle
• Howard Ide Wagner Jr., DDS
• Jamie Lynn Wagner
• Wal-Mart Stores East LP
• Walgreen Co
• Robert Wallace
• Deborah J.R.G. Warner, PH.D.
• Ryan Watari, OD

• Pediatrics Physician in Littleton, NH
• Providers in Littleton, NH by specialty
• Pediatrics Physician in New Hampshire

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2017; 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.