Basic Information
| Provider Information | |||||||||
| NPI: | 1972551158 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WEXLER | ||||||||
| FirstName: | LAURA | ||||||||
| MiddleName: | FOONER | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 636256 | ||||||||
| Address2: | CENTRAL CREDENTIALING | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452636256 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5132453104 | ||||||||
| FaxNumber: | 5135855511 | ||||||||
| Practice Location | |||||||||
| Address1: | 3200 VINE ST | ||||||||
| Address2: | CARDIOLOGY SECTION IIIC | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452202213 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5134756383 | ||||||||
| FaxNumber: | 5134756389 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2006 | ||||||||
| LastUpdateDate: | 07/07/2017 | ||||||||
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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 | 35-056197 | OH | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0000X | 35-056197 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 0694851 | 05 | OH | MEDICAID | 64862568 | 05 | KY | MEDICAID | 200148430 | 05 | IN | MEDICAID |