Provider Demographics
NPI:1700143161
Name:WAGNER, JUDIT (MD)
Entity Type:Individual
Prefix:DR
First Name:JUDIT
Middle Name:
Last Name:WAGNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 ASHLEY DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620-3330
Mailing Address - Country:US
Mailing Address - Phone:585-461-1466
Mailing Address - Fax:585-244-9367
Practice Address - Street 1:300 ASHLEY DR
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620-3330
Practice Address - Country:US
Practice Address - Phone:585-461-1466
Practice Address - Fax:585-244-9367
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-23
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY123309-1207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology