PHYLLIS J WAGNER (NPI# 1770609844) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1770609844 |
| Entity Type | Individual |
| Full Name | PHYLLIS J WAGNER |
| Credential | MD |
| Practice Address |
4 Crawford St Cambridge MA 02139-1624 |
| Mailing Address |
Po Box 380042 Cambridge MA 02238-0042 |
| Practice Telephone | 6174922855 |
| Enumeration Date | 2007-03-21 |
| Last Update Date | 2008-11-04 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208000000X | Pediatrics | 37927 | MA | Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609157569 | Phyllis A. Wagner | Nurse Practitioner | 3390 Sw 131st Ter, Davie, FL 33330-4618 | 2011-09-06 |
| 1770697096 | Phyllis J Wagner | Occupational Therapy Assistant | 4635 Union Rd, Cheektowaga, NY 14225-1851 | 2006-08-17 |
| Street Address |
4 CRAWFORD ST |
| City | CAMBRIDGE |
| State | MA |
| Zip Code | 02139-1624 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598316044 | Diane Greenleaf | Registered Nurse | Cha Windsor Clinic, 119 Windsor St, Cambridge, MA 02139 | 2019-09-26 |
| 1730738345 | Martin Bednar | Student in an Organized Health Care Education/Training Program | 350 Massachusetts Avenue, Cambridge, MA 02139 | 2019-09-06 |
| 1861050049 | Rebecca Marie Addison | Dietitian, Registered | 75 Auburn St, Cambridge, MA 02139 | 2019-06-03 |
| 1285103051 | Jenna Halloran | Social Worker | 929 Massaschusetts Ave, Cambridge, MA 02139 | 2018-11-21 |
| 1750859286 | Lisa Marie Keovongsa | Dietitian, Registered | 186 1/2 Hampshire St., Cambridge, MA 02139 | 2018-11-02 |
| 1245714237 | Eleanor Coffin | Occupational Therapist | 1483 Cambridge St, Cambridge, MA 02139 | 2018-09-17 |
| 1649758277 | Sariya Idriss | Social Worker | Cambridge Health Alliance, 1493 Cambridge St., Cambridge, MA 02139 | 2018-08-06 |
| 1538647151 | Ari Pehkonen | Social Worker | Cambridge Health Alliance, Cambridge Hospital, 1493 Cambridge St., Cambridge, MA 02139 | 2018-08-06 |
| 1972080893 | Esther Cazeau | Counselor | 237 Hampshire St., Cambridge, MA 02139 | 2018-07-24 |
| 1528596533 | Adam Liebling | Acupuncturist | 11 Fiske Pl., Cambridge, MA 02139 | 2017-06-03 |
| Find all providers in zip 02139 | ||||
| Taxonomy Code | 208000000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certificatio - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255878922 | Jean C Kelley, Md | Pediatrics | 61 Fresh Pond Pkwy, Cambridge, MA 02138-3348 | 2017-01-19 |
| 1922493774 | Amy W Fan | Pediatrics | 575 Mount Auburn St Ste 202, Cambridge, MA 02138-4627 | 2015-03-30 |
| 1912343260 | Mary P Alexander | Pediatrics | 799 Concord Ave # 4, Cambridge, MA 02138-1048 | 2013-05-14 |
| 1053624452 | Gina Exantus-bernard | Pediatrics | 400 Byrn St Ste A, Cambridge, MD 21613 | 2010-07-14 |
| 1336260587 | Charles J Homer | Pediatrics | Nichq, 20 University Road, Cambridge, MA 02138 | 2007-04-03 |
| 1083743967 | Brian L Hamilton | Pediatrics | Merimack Pharmaceuticals, 101 Binney Street, Cambridge, MA 02142 | 2007-03-05 |
| 1497881239 | Erin Margaret Mahony | Pediatrics | 799 Concord Avenue, Belmont Cambridge Health Care, Cambridge, MA 02138 | 2007-02-26 |
| 1073662037 | Julia Fowler Aquino | Pediatrics | 110 2nd St Ph 15, Cambridge, MA 02141-2147 | 2007-01-09 |
| 1629153119 | Edna J Dycoco | Pediatrics | 64979 Old Twenty On Road, Cambridge, OH 43725-9619 | 2006-10-25 |
| 1982717302 | Suresh Chandra Prabhudas Thakker | Pediatrics | 1420 Clark St, Cambridge, OH 43725-9617 | 2006-08-17 |
| Find all providers in CAMBRIDGE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.