Basic Information
Provider Information
NPI: 1841511565
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WEXLER
FirstName: SONYA
MiddleName: JAIRAJ
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3401 N BROAD ST
Address2:  
City: PHILADELPHIA
State: PA
PostalCode: 191405103
CountryCode: US
TelephoneNumber: 2157072000
FaxNumber:  
Practice Location
Address1: 3509 N BROAD ST
Address2: DEPT OF OTOLARYNGOLOGY, 6TH FLOOR
City: PHILADELPHIA
State: PA
PostalCode: 191404105
CountryCode: US
TelephoneNumber: 2157073665
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/16/2010
LastUpdateDate: 08/16/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Y00000XMT197995PAY Allopathic & Osteopathic PhysiciansOtolaryngology 

No ID Information.


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