Provider Demographics
NPI:1578212684
Name:WAGNER, ANUSHRI KUSHWAHA (DO)
Entity type:Individual
Prefix:
First Name:ANUSHRI
Middle Name:KUSHWAHA
Last Name:WAGNER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:831 HEALEY LN
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-6343
Mailing Address - Country:US
Mailing Address - Phone:832-585-2402
Mailing Address - Fax:
Practice Address - Street 1:4205 BEN FRANKLIN BLVD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-2143
Practice Address - Country:US
Practice Address - Phone:919-477-6900
Practice Address - Fax:919-620-0974
Is Sole Proprietor?:No
Enumeration Date:2022-03-23
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2025-00673207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine