Healthcare Provider Details

I. General information

NPI: 1215324900
Provider Name (Legal Business Name): JASON WEXLER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2015
Last Update Date: 08/19/2025
Certification Date: 08/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6300 BRIDGETON CT
SPRINGFIELD VA
22152-1302
US

IV. Provider business mailing address

6300 BRIDGETON CT
SPRINGFIELD VA
22152-1302
US

V. Phone/Fax

Practice location:
  • Phone: 410-929-0373
  • Fax:
Mailing address:
  • Phone: 410-929-0373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0101272933
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD047575
License Number StateDC
# 4
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA169049
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberD86312
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: