Healthcare Provider Details

I. General information

NPI: 1821069824
Provider Name (Legal Business Name): NATHANIEL C. WEBSTER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2006
Last Update Date: 12/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 NORTHLAND AVE
BUFFALO NY
14208-1114
US

IV. Provider business mailing address

4979 HARLEM RD
AMHERST NY
14226-2547
US

V. Phone/Fax

Practice location:
  • Phone: 716-882-8989
  • Fax: 716-689-2238
Mailing address:
  • Phone: 716-923-4390
  • Fax: 716-923-4394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number087347-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: