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General NPI Number Information
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NPI Number | 1801858865
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Entity Type | Individual
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Provider Name | MOSHE MARK DOUGLAS WEXLER PH.D.
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Gender | Male
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Dates
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Enumeration Date | 04/05/2006
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Last Update Date | 06/20/2024
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Provider Practice Location Address
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Address Line | 316 CALHOUN ST
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City | CHARLESTON
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State | SC
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Zip | 29401-1113
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Country | US
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Telephone | 843-724-3324
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 751649
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City | CHARLOTTE
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State | NC
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Zip | 28275-1649
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Country | US
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Telephone | 888-472-0043
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 1445
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License Number State | SC
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