Provider Demographics
NPI:1811740947
Name:WAGNER, BRIANNA KATHRYN MCMAHON
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:KATHRYN MCMAHON
Last Name:WAGNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2297 BEREN LN
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-7414
Mailing Address - Country:US
Mailing Address - Phone:443-201-6940
Mailing Address - Fax:
Practice Address - Street 1:412 MALCOLM DR STE 200
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-6174
Practice Address - Country:US
Practice Address - Phone:410-751-7930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-09
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program