Provider Demographics
NPI:1285633073
Name:WEBSTER, MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:WEBSTER
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 1:300 STATE STREET
Mailing Address - Street 2:SUITE 301
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16507-1430
Mailing Address - Country:US
Mailing Address - Phone:814-877-7907
Mailing Address - Fax:814-877-6791
Practice Address - Street 1:300 STATE ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16507-1427
Practice Address - Country:US
Practice Address - Phone:814-877-7907
Practice Address - Fax:814-877-6791
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD060367L208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
G56776Medicare UPIN
PA0016568090001Medicaid
NY00025197901OtherUNIVERA
PA212697OtherUPMC
OH2217649OtherOH MEDICAID
G56776Medicare UPIN
PA000403E7CMedicare PIN
NY01982452OtherNY MEDICAID
PA69103OtherUNISON
PA1015657OtherAETNA
PA953223OtherBLUE SHIELD