Provider Demographics
NPI:1952581944
Name:WEBSTER, MARK D (PA-C)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:D
Last Name:WEBSTER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2424 HILL AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45044-4732
Mailing Address - Country:US
Mailing Address - Phone:937-231-1250
Mailing Address - Fax:
Practice Address - Street 1:215 S ALLISON AVE
Practice Address - Street 2:
Practice Address - City:XENIA
Practice Address - State:OH
Practice Address - Zip Code:45385-3694
Practice Address - Country:US
Practice Address - Phone:937-376-2571
Practice Address - Fax:937-376-2930
Is Sole Proprietor?:No
Enumeration Date:2007-11-07
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1025363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical