Provider Demographics
NPI:1942301304
Name:WEBBER, GEORGE ETHEN (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:ETHEN
Last Name:WEBBER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 STATE RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:KITTERY
Mailing Address - State:ME
Mailing Address - Zip Code:03904-1564
Mailing Address - Country:US
Mailing Address - Phone:207-439-4123
Mailing Address - Fax:
Practice Address - Street 1:74 STATE RD
Practice Address - Street 2:SUITE 104
Practice Address - City:KITTERY
Practice Address - State:ME
Practice Address - Zip Code:03904-1564
Practice Address - Country:US
Practice Address - Phone:207-439-4123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME118912084P0800X
NH72202084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MM0709Medicare ID - Type Unspecified
A67583Medicare UPIN