Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Ethan Scott Wagner, MD

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1174324420

Ethan Scott Wagner, MD is a Student in an Organized Health Care Education/Training Program in Boston, Massachusetts. Practices as a sole proprietor. Licensed in Massachusetts.

Licensed in
MA
In the registry since
2025
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

55 Fruit St
Boston, MA 02114-2621
Phone: (617) 726-2000
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Student in an Organized Health Care Education/Training Program (primary) Taxonomy 390200000X · Licence PENDING (MA)

Record details

NPI number1174324420
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorYes
NPI enumeratedMarch 22, 2025
Last updated in NPPESMarch 22, 2025
Certification dateMarch 22, 2025
Mailing address55 Fruit St, Boston, MA 02114-2621

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