MEDICARE: ERICA WEBSTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

General Provider Information

NPI Number	:	1801201975
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERICA WEBSTER

Provider Business Mailing Address
First Line	:	3652 HOOVER AVE
Second Line	:	BUILDING
City	:	ENDICOTT
State	:	NY
Zip	:	13760
Country	:	US
Telephone Number	:	607-346-6023
Fax Number	:

Provider Business Practice Location Address
First Line	:	3652 HOOVER AVE
Second Line	:	BUILDING
City	:	ENDICOTT
State	:	NY
Zip	:	13760-3608
Country	:	US
Telephone Number	:	607-346-6023
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/26/2014
Last Update Date	:	06/26/2014

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Directions to “ ERICA WEBSTER ” Practice Location

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