Provider Demographics
NPI:1336129220
Name:WEBB, DESIREE M (MD)
Entity Type:Individual
Prefix:DR
First Name:DESIREE
Middle Name:M
Last Name:WEBB
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:300 E MAIN ST
Mailing Address - Street 2:PO BOX 189
Mailing Address - City:REYNOLDSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15851-1282
Mailing Address - Country:US
Mailing Address - Phone:814-371-1510
Mailing Address - Fax:814-371-2922
Practice Address - Street 1:529 SUNFLOWER DR
Practice Address - Street 2:
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-2378
Practice Address - Country:US
Practice Address - Phone:814-371-1510
Practice Address - Fax:814-371-2922
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2011-06-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD417833208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102241427Medicaid
PAI32466Medicare UPIN
PA091985Medicare PIN