Healthcare Provider Details

I. General information

NPI: 1801858865
Provider Name (Legal Business Name): MOSHE MARK DOUGLAS WEXLER PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MARK D WEXLER PH.D.

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 06/20/2024
Certification Date: 06/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 CALHOUN ST
CHARLESTON SC
29401-1113
US

IV. Provider business mailing address

PO BOX 751649
CHARLOTTE NC
28275-1649
US

V. Phone/Fax

Practice location:
  • Phone: 843-724-3324
  • Fax:
Mailing address:
  • Phone: 888-472-0043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number1445
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: