Healthcare Provider Details

I. General information

NPI: 1033309497
Provider Name (Legal Business Name): SYLVIA ALFREDA WEBSTER D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2007
Last Update Date: 07/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 N BROAD ST RM 821
PHILADELPHIA PA
19102-1510
US

IV. Provider business mailing address

PO BOX 540
HAVERFORD PA
19041-0540
US

V. Phone/Fax

Practice location:
  • Phone: 215-568-0860
  • Fax: 215-568-0769
Mailing address:
  • Phone: 610-642-2296
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberOS003744L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: