Basic Information
| Provider Information | |||||||||
| NPI: | 1306874441 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WEBNER | ||||||||
| FirstName: | DAVID | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 190 W SPROUL RD | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | SPRINGFIELD | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190642027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6103288830 | ||||||||
| FaxNumber: | 6103288981 | ||||||||
| Practice Location | |||||||||
| Address1: | 196 W SPROUL RD | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | SPRINGFIELD | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190642045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6103288830 | ||||||||
| FaxNumber: | 6103288981 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2006 | ||||||||
| LastUpdateDate: | 03/17/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD421524 | PA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207QS0010X | MD421524 | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1010411720003 | 05 | PA | MEDICAID |