MEDICARE: DENISE WEBB D.P.M.

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	213E00000X	Podiatrist	SC-003751-L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000432603	OTHER	PA	INDIVIDUAL HIGHMARK ID
2	020749800	OTHER		INDIVIDUAL HMO ID
3	001757566	OTHER	PA	HIGHMARK BLUE SHIELD ID
4	2423519000	OTHER	PA	10-DIGIT HMO ID

General Provider Information

NPI Number	:	1750313367
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENISE WEBB D.P.M.

Provider Business Mailing Address
First Line	:	3429 ASHVILLE ST
Second Line	:
City	:	PHILA
State	:	PA
Zip	:	19136-3019
Country	:	US
Telephone Number	:	215-338-9861
Fax Number	:	215-725-5834

Provider Business Practice Location Address
First Line	:	2813 COTTMAN AVE
Second Line	:
City	:	PHILA
State	:	PA
Zip	:	19149-1421
Country	:	US
Telephone Number	:	215-332-9666
Fax Number	:	215-725-5834

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

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	07/08/2007

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