Provider Demographics
NPI:1235459116
Name:WAGLE, NEIL WATTSON (MD)
Entity type:Individual
Prefix:DR
First Name:NEIL
Middle Name:WATTSON
Last Name:WAGLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:NEIL
Other - Middle Name:
Other - Last Name:WAGLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:248 WINCHESTER ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-2767
Mailing Address - Country:US
Mailing Address - Phone:617-256-6666
Mailing Address - Fax:
Practice Address - Street 1:75 FRANCIS ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-6110
Practice Address - Country:US
Practice Address - Phone:617-732-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-02
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA244653207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine