Provider Demographics
NPI:1700024940
Name:WAGNER, JESSICA L (MD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:L
Last Name:WAGNER
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:2730 UNIVERSITY BLVD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:WHEATON
Mailing Address - State:MD
Mailing Address - Zip Code:20902-1979
Mailing Address - Country:US
Mailing Address - Phone:301-942-8799
Mailing Address - Fax:301-933-8554
Practice Address - Street 1:2730 UNIVERSITY BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:WHEATON
Practice Address - State:MD
Practice Address - Zip Code:20902-1979
Practice Address - Country:US
Practice Address - Phone:301-942-8799
Practice Address - Fax:301-933-8554
Is Sole Proprietor?:No
Enumeration Date:2009-01-27
Last Update Date:2011-06-03
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Provider Licenses
StateLicense IDTaxonomies
MDH70799207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology