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General NPI Number Information
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NPI Number | 1104519966
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Entity Type | Organization
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Legal Business Name | WEXFORD HEALTH SOLUTIONS
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Dates
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Enumeration Date | 05/30/2023
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Last Update Date | 07/11/2023
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Provider Practice Location Address
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Address Line | 94 GRAPEVINE RD
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City | MARTINSBURG
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State | WV
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Zip | 25405-3434
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Country | US
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Telephone | 630-730-0302
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Fax |
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Provider Business Mailing Address
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Address Line | 4006 CANDLE LIGHT DR
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City | DAYTON
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State | MD
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Zip | 21036-1141
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Country | US
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Telephone | 630-730-0302
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | NILAY B THAKER
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Credential | DO
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Telephone | 630-730-0302
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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