Provider Demographics
NPI:1285671404
Name:WAGNER, ANDREW J (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:J
Last Name:WAGNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:44 BINNEY ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-6013
Mailing Address - Country:US
Mailing Address - Phone:617-632-5204
Mailing Address - Fax:617-632-3408
Practice Address - Street 1:44 BINNEY STREET
Practice Address - Street 2:DANA FARBER CANCER INST.
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115
Practice Address - Country:US
Practice Address - Phone:617-632-4899
Practice Address - Fax:617-632-3408
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2007-08-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA159908207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology