Provider Demographics
NPI:1518962000
Name:WEBLEY-BETHUNE, PATRICIA (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:
Last Name:WEBLEY-BETHUNE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 NEW LN
Mailing Address - Street 2:
Mailing Address - City:SELDEN
Mailing Address - State:NY
Mailing Address - Zip Code:11784-3322
Mailing Address - Country:US
Mailing Address - Phone:631-736-7220
Mailing Address - Fax:631-736-7307
Practice Address - Street 1:12 NEW LN
Practice Address - Street 2:
Practice Address - City:SELDEN
Practice Address - State:NY
Practice Address - Zip Code:11784-3322
Practice Address - Country:US
Practice Address - Phone:631-736-7220
Practice Address - Fax:631-736-7307
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY182907-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY182907-1OtherMEDICAL LISCENSE
NY01693356Medicaid
NYE62858Medicare UPIN
NY66F781Medicare ID - Type Unspecified