Provider Demographics
NPI:1023574159
Name:WAGNER, MARIE-SOLEIL (MD, MS)
Entity Type:Individual
Prefix:DR
First Name:MARIE-SOLEIL
Middle Name:
Last Name:WAGNER
Suffix:
Gender:F
Credentials:MD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1197 LLOYD-GEORGE
Mailing Address - Street 2:
Mailing Address - City:VERDUN
Mailing Address - State:QC
Mailing Address - Zip Code:H4H 2P2
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3175 CHEMIN DE LA COTE-STE-CATHERINE
Practice Address - Street 2:
Practice Address - City:MONTREAL
Practice Address - State:QC
Practice Address - Zip Code:H3T 1C5
Practice Address - Country:CA
Practice Address - Phone:514-345-4706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-13
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA-84379207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology