Provider Demographics
NPI:1750313367
Name:WEBB, DENISE (DPM)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:WEBB
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3429 ASHVILLE ST
Mailing Address - Street 2:
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19136-3019
Mailing Address - Country:US
Mailing Address - Phone:215-338-9861
Mailing Address - Fax:215-725-5834
Practice Address - Street 1:2813 COTTMAN AVE
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19149-1421
Practice Address - Country:US
Practice Address - Phone:215-332-9666
Practice Address - Fax:215-725-5834
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC-003751-L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000432603OtherINDIVIDUAL HIGHMARK ID
020749800OtherINDIVIDUAL HMO ID
PA001757566OtherHIGHMARK BLUE SHIELD ID
PA2423519000Other10-DIGIT HMO ID
020749800OtherINDIVIDUAL HMO ID