Ethan Wagner, MD
NPI 1174324420 · Student in an Organized Health Care Education/Training Program · Boston, MA
Enrolled with Medicare as Order and Referring Only - Internal Medicine · source: CMS PECOS Public Provider Enrollment (2026.04.01)
Ethan Wagner, MD is a Student in an Organized Health Care Education/Training Program provider in Boston, MA (NPI 1174324420).
Provider details
- NPI number
- 1174324420
- Entity type
- Individual
- Primary specialty
- Student in an Organized Health Care Education/Training ProgramStudent, Health Care
- Credential
- MD
- Sex
- Male
- Sole proprietor
- Yes
- License
- PENDING (MA)
Specialties & taxonomies
Student, Health Care
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
1 yr in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
Mailing address
Registry dates
- Enumerated
- 2025-03-22
- Last updated
- 2025-03-22
- Certified
- 2025-03-22
Frequently asked questions
- What is Ethan Wagner's NPI number?
- Ethan Wagner's National Provider Identifier (NPI) is 1174324420, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What is Ethan Wagner's specialty?
- Ethan Wagner is listed in the NPPES registry with a primary specialty of Student in an Organized Health Care Education/Training Program (Student, Health Care).
- Where is Ethan Wagner located?
- Ethan Wagner's practice location on file with NPPES is 55 Fruit St, Boston, MA 02114-2621.
- What is Ethan Wagner's phone number?
- The practice phone number listed in the NPPES registry for Ethan Wagner is (617) 726-2000.
- Does Ethan Wagner accept Medicare?
- Ethan Wagner is approved to bill Medicare according to CMS PECOS enrollment data (2026.04.01). Confirm current participation with the provider before scheduling.
- Is Ethan Wagner's NPI active?
- Yes — Ethan Wagner's NPI (1174324420) is active in the NPPES registry as of the last update on 2025-03-22.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.