Healthcare Provider Details

I. General information

NPI: 1356490163
Provider Name (Legal Business Name): LAUREN ALBERTA-WSZOLEK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 07/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6565 WEST LOOP S SUITE 800
BELLAIRE TX
77401-3500
US

IV. Provider business mailing address

290 BAKER AVE SUITE 800
CONCORD MA
01742-2189
US

V. Phone/Fax

Practice location:
  • Phone: 713-661-4383
  • Fax: 713-661-4346
Mailing address:
  • Phone: 713-661-4383
  • Fax: 713-661-4346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberPENDING
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number239990
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: