Provider Demographics
NPI:1750429007
Name:WEBSTER, RAYMOND (MD)
Entity type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:
Last Name:WEBSTER
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 1:2 HAMPTON CT
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050-3021
Mailing Address - Country:US
Mailing Address - Phone:516-767-3774
Mailing Address - Fax:516-472-7077
Practice Address - Street 1:2 HAMPTON CT
Practice Address - Street 2:
Practice Address - City:PORT WASHINGTON
Practice Address - State:NY
Practice Address - Zip Code:11050-3021
Practice Address - Country:US
Practice Address - Phone:516-472-7077
Practice Address - Fax:516-472-7078
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY164367207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2C0498OtherHEALTHNET
NY0004131927OtherUNITED HEALTHCARE
NY152287OtherAMERIHEALTH
NYRW013F3310OtherBLUE CROSS BLUE SHIELD
NYGHI PPOOther0056263
NYGHI PPOOther0056263
NY152287OtherAMERIHEALTH