JESSE WAGNER MD (Credential# 554427) is licensed (Physician/surgeon) with Connecticut Department of Consumer Protection. The license effective date is June 1, 2020. The license expiration date date is May 31, 2021. The license status is ACTIVE.
JESSE WAGNER MD is licensed with the Department of Consumer Protection of Connecticut. The credential number is #1.036836. The credential type is physician/surgeon. The effective date is June 1, 2020. The expiration date is May 31, 2021. The business address is 25 Lake Ridge Dr, Marlborough, CT 06447. The current status is active.
| Licensee Name | JESSE WAGNER MD |
| Credential ID | 554427 |
| Credential Number | 1.036836 |
| Credential Type | Physician/Surgeon |
| Business Address |
25 Lake Ridge Dr Marlborough CT 06447 |
| Business Type | INDIVIDUAL |
| Status | ACTIVE - CURRENT |
| Active | 1 |
| Issue Date | 1998-05-01 |
| Effective Date | 2020-06-01 |
| Expiration Date | 2021-05-31 |
| Refresh Date | 2020-04-29 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 193883 | CSP.0026883 | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER | 1999-03-01 | 2019-03-01 - 2021-02-28 | ACTIVE |
| Street Address | 25 Lake Ridge Dr |
| City | Marlborough |
| State | CT |
| Zip Code | 06447 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Ruth L Wagner | 25 Lake Ridge Dr, Marlborough, CT 06447-1326 | Registered Nurse | 2020-05-01 ~ 2021-04-30 |
| Kathy P Salinsky · William Raveis Real Estate | 25 Lake Ridge Dr, Marlborough, CT 06447 | Real Estate Salesperson | 1997-06-01 ~ 1998-05-31 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Linda T Nachtigal Dvm | 86 Saner Road, Marlborough, CT 06447 | Veterinarian | 2020-07-01 ~ 2021-06-30 |
| Victoria Demari Cartagena | 113 Hebron Road, Marlborough, CT 06447 | Registered Nurse | 2020-07-01 ~ 2021-06-30 |
| Christina L Abrahamson · Lonergan | 47 South Stonybrook Drive, Marlborough, CT 06447 | Dental Hygienist | 2020-08-01 ~ 2021-07-31 |
| Bozena M Michalski · Marcowka | 18 Portland Rd, Marlborough, CT 06447 | Registered Nurse | 2020-08-01 ~ 2021-07-31 |
| Benedict C Valentine II | 8 Independence Drive, Marlborough, CT 06447 | Podiatrist | 2020-06-01 ~ 2021-05-31 |
| Nicolette M Banbury | 21 Cheney Road, Marlborough, CT 06447 | Professional Counselor | 2020-09-01 ~ 2021-08-31 |
| Lynn E Wohlfert | 117 North Main Street, Marlborough, CT 06447 | Notary Public Appointment | 2020-10-01 ~ 2025-09-30 |
| Jo-ellen D Beam | 120 Edstrom Rd, Marlborough, CT 06447 | Registered Nurse | 2020-07-01 ~ 2021-06-30 |
| Kevin J Pease | 82 South Main St, Marlborough, CT 06447 | Licensed Practical Nurse | 2020-08-01 ~ 2021-07-31 |
| Lea L Lee | 38 Keirstead Circle, Marlborough, CT 06447 | Registered Nurse | 2020-07-01 ~ 2021-06-30 |
| Find all Licenses in zip 06447 | |||
| City | Marlborough |
| Zip Code | 06447 |
| License Type | Physician/Surgeon |
| License Type + County | Physician/Surgeon + Marlborough |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Henry W Wagner | 30 North St, Rye, NY 10580 | Physician/surgeon | 2001-01-31 ~ 2002-01-31 |
| Karla L Wagner | 19 Wright St #2, Stamford, CT 06902 | Physician/surgeon | 1993-12-01 ~ 1994-10-31 |
| Jesse Schomer Md | 131 Kings Hwy N, Westport, CT 06880 | Physician/surgeon | 2007-06-19 ~ 2008-08-31 |
| Jesse Lee Saliga | 1 Lafountain Rd, Suffield, CT 06078-2252 | Physician/surgeon | 2020-07-01 ~ 2021-06-30 |
| Jesse M Chua-reyes Md | Po Box 158, Middletown, CT 06457-0158 | Physician/surgeon | 2020-06-01 ~ 2021-05-31 |
| Jesse N Hochman | 390 Commonwealth Ave., Boston, MA 02215 | Physician/surgeon | 2004-12-28 ~ 2005-12-31 |
| Douglas J Anderson | 8 Jesse Ct, Montville, NJ 07045-9016 | Physician/surgeon | 2018-02-01 ~ 2019-01-31 |
| Jesse M Cedarbaum | 16 Old Barnabas Rd, Woodbridge, CT 06525-1923 | Physician/surgeon | 2017-08-01 ~ 2018-07-31 |
| Jeffrey A Wagner Md | 30 Davis Hill Rd, Weston, CT 06883 | Physician/surgeon | 2020-05-01 ~ 2021-04-30 |
| Lloyd D Wagner | 223 24th St, Santa Monica, CA 90402-2515 | Physician/surgeon | 2019-11-01 ~ 2020-10-31 |
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| Data Provider | Connecticut Department of Consumer Protection |
| Jurisdiction | Connecticut |
| Related Datasets | Connecticut Business Registrations, Connecticut Child Care Facilities |
This dataset includes 1.41 million licenses issued wtih Connecticut Department of Consumer Protection (TDLR).