John Wagner, MD

Primary specialty

Neuromusculoskeletal Medicine & OMM PhysicianTaxonomy code 204D00000X

License

028497 Issued in VA

Practice address

6275 E Virginia Beach Blvd
Suite 300
Norfolk, VA 23502-2851

Phone

(757) 461-1688

Fax

(757) 455-5865

NPI assigned

Jan 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

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1136246400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1206921600000",
    "number": "1952389710",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6275 E VIRGINIA BEACH BLVD",
            "address_2": "SUITE 300",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235022851",
            "telephone_number": "757-461-1688",
            "fax_number": "757-455-5865"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6275 E VIRGINIA BEACH BLVD",
            "address_2": "SUITE 300",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235022851",
            "telephone_number": "757-461-1688",
            "fax_number": "757-455-5865"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "JOHN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-03",
        "last_updated": "2008-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "204D00000X",
            "taxonomy_group": "",
            "desc": "Neuromusculoskeletal Medicine & OMM",
            "state": "VA",
            "license": "028497",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE LEGACY GROUP",
            "identifier": "C00101",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE GROUP#",
            "identifier": "CC7688",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Taylor Elena Waddell, BSN, RN
• Tracy L. Waddell, RDH
• Wagner Kapoor Research Institute LLC
• Alan Lewis Wagner, MD
• Heidi Wagner, C.P.O.
• Katelyn Shelby Wagner, LMFT
• Maxwell Solomon Wagner, MD
• Todd L Wagner, D.O., M.P.H.
• Melissa Waide, CPNP
• Lance Waite

• Neuromusculoskeletal Medicine & OMM Physician in Norfolk, VA
• Providers in Norfolk, VA by specialty
• Neuromusculoskeletal Medicine & OMM Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2008; 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.