Basic Information
| Provider Information | |||||||||
| NPI: | 1699909432 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WAGNER | ||||||||
| FirstName: | ANJA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2660 MAIN ST | ||||||||
| Address2: | STE 216 | ||||||||
| City: | BRIDGEPORT | ||||||||
| State: | CT | ||||||||
| PostalCode: | 066065301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2036963495 | ||||||||
| FaxNumber: | 2035816509 | ||||||||
| Practice Location | |||||||||
| Address1: | 2979 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | BRIDGEPORT | ||||||||
| State: | CT | ||||||||
| PostalCode: | 066064284 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2036835100 | ||||||||
| FaxNumber: | 2036835140 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/07/2009 | ||||||||
| LastUpdateDate: | 10/10/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 050151 | CT | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No ID Information.