Provider Demographics
NPI:1740053032
Name:WAGNER, KAY IRENE (DVM)
Entity type:Individual
Prefix:DR
First Name:KAY
Middle Name:IRENE
Last Name:WAGNER
Suffix:
Gender:F
Credentials:DVM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1929 ALBERT RILL RD
Mailing Address - Street 2:
Mailing Address - City:HAMPSTEAD
Mailing Address - State:MD
Mailing Address - Zip Code:21074-1022
Mailing Address - Country:US
Mailing Address - Phone:410-239-3713
Mailing Address - Fax:410-374-0657
Practice Address - Street 1:1929 ALBERT RILL RD
Practice Address - Street 2:
Practice Address - City:HAMPSTEAD
Practice Address - State:MD
Practice Address - Zip Code:21074-1022
Practice Address - Country:US
Practice Address - Phone:410-239-3713
Practice Address - Fax:410-374-0657
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MD3729208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice