Provider Demographics
NPI:1396769964
Name:WEBSTER, JULIE S (MD)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:S
Last Name:WEBSTER
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:PO BOX 60100
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29419-0100
Mailing Address - Country:US
Mailing Address - Phone:800-922-0346
Mailing Address - Fax:843-569-8509
Practice Address - Street 1:101 E WOOD ST
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-3040
Practice Address - Country:US
Practice Address - Phone:864-560-6000
Practice Address - Fax:706-653-1162
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2019-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCMD192602085B0100X
SCME192602085N0904X, 2085P0229X, 2085R0202X, 2085R0204X, 2085U0001X, 2085B0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
No2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC2001OtherMEDICARE GROUP
NC7906117Medicaid
SC192605Medicaid
NC7906117Medicaid
SC2001OtherMEDICARE GROUP
300081721Medicare ID - Type UnspecifiedRR