Provider Demographics
NPI:1821069824
Name:WEBSTER, NATHANIEL C (MD)
Entity Type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:C
Last Name:WEBSTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:4979 HARLEM RD
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-2547
Mailing Address - Country:US
Mailing Address - Phone:716-923-4390
Mailing Address - Fax:716-923-4394
Practice Address - Street 1:15 NORTHLAND AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14208-1114
Practice Address - Country:US
Practice Address - Phone:716-882-8989
Practice Address - Fax:716-689-2238
Is Sole Proprietor?:No
Enumeration Date:2006-01-28
Last Update Date:2011-12-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY087347-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00643229Medicaid
NY038071Medicare ID - Type Unspecified
NY00643229Medicaid