Basic Information
| Provider Information | |||||||||
| NPI: | 1730179342 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WEXLER | ||||||||
| FirstName: | DEBORAH | ||||||||
| MiddleName: | JANE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 9142 | ||||||||
| Address2: | |||||||||
| City: | CHARLESTOWN | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021299142 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6177248722 | ||||||||
| FaxNumber: | 6177248534 | ||||||||
| Practice Location | |||||||||
| Address1: | 50 STANIFORD ST | ||||||||
| Address2: | DIABETES CENTER | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021142517 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6177268722 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/25/2005 | ||||||||
| LastUpdateDate: | 08/01/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 215101 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 207RE0101X | 215101 | MA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
ID Information
| ID | Type | State | Issuer | Description | 467329 | 01 | MA | TUFTS HEALTH PLAN | OTHER | J26967 | 01 | MA | BCBS MA | OTHER | 2027411 | 05 | MA | MEDICAID |