Provider Demographics
NPI:1225004302
Name:WEBB, PAUL RICHARD (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:RICHARD
Last Name:WEBB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 GUTHRIE SQ
Mailing Address - Street 2:
Mailing Address - City:SAYRE
Mailing Address - State:PA
Mailing Address - Zip Code:18840-1625
Mailing Address - Country:US
Mailing Address - Phone:570-888-5858
Mailing Address - Fax:
Practice Address - Street 1:41883 ROUTE 6
Practice Address - Street 2:
Practice Address - City:WYALUSING
Practice Address - State:PA
Practice Address - Zip Code:18853-9002
Practice Address - Country:US
Practice Address - Phone:570-746-3500
Practice Address - Fax:570-746-3545
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY162315-1207R00000X
PAMD035684E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00960641Medicaid
PA0010469530003Medicaid
PACC9269OtherRR MEDICARE GROUP
PAGU039760OtherPA MEDICARE GROUP
PA110209179OtherRR MEDICARE PIN
PA0010469530003Medicaid
NY00960641Medicaid