Individual ProviderDiana H WagmanPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address33 Sewall St, Portland, ME 04102-2603(207) 828-2100(207) 482-7800PECOS EnrollmentBased on the most recent information from CMS, provider Diana H Wagman does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 2:35 PM.Profile DetailsProvider ID1013060896Provider TypeIndividualFull NameWagman, Diana HCredentialPA-CGenderFemaleSole ProprietorNoEnumeration Date1/18/2007Last Updated11/11/2015Contact InformationPractice LocationPractice Address33 Sewall St, Portland, ME 04102-2603Phone(207) 828-2100FaxUnlisted FaxMailing LocationMailing Address324 Gannett Dr Ste 200, South Portland, ME 04106-3266Phone(207) 482-7800FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode363A00000XPrimaryDescriptionPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersLicensePA260Maine