Provider Demographics
NPI:1811390560
Name:WEBB, ANIKA (PA)
Entity Type:Individual
Prefix:
First Name:ANIKA
Middle Name:
Last Name:WEBB
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:160 SOUTH RAILROAD STREET
Mailing Address - Street 2:STATION SQUARE
Mailing Address - City:TROY
Mailing Address - State:PA
Mailing Address - Zip Code:16947-1499
Mailing Address - Country:US
Mailing Address - Phone:570-297-4555
Mailing Address - Fax:570-297-4777
Practice Address - Street 1:160 SOUTH RAILROAD STREET
Practice Address - Street 2:STATION SQUARE
Practice Address - City:TROY
Practice Address - State:PA
Practice Address - Zip Code:16947-1499
Practice Address - Country:US
Practice Address - Phone:570-297-4555
Practice Address - Fax:570-297-4777
Is Sole Proprietor?:No
Enumeration Date:2014-10-08
Last Update Date:2014-12-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOA003383363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA376944YDFUMedicare PIN