Individual
MARK C WEBSTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
114 S SHORE RD, OLD FORGE, NY 13420-3500
(315) 369-6619
(315) 369-6533
Mailing address
PO BOX 207, OLD FORGE, NY 13420-0207
(315) 369-6619
(315) 369-6533
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
124353
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00552974
—
NY
01
—
0075950
GHI
NY
01
—
441081441
RAILROAD MEDICARE
NY
Enumeration date
12/15/2005
Last updated
05/22/2008
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