1962590844 NPI number — ANTHONY ORVILLE ROBERTS M.D.

Table of content: ANTHONY ORVILLE ROBERTS M.D. (NPI 1962590844)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962590844 NPI number — ANTHONY ORVILLE ROBERTS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROBERTS
Provider First Name:
ANTHONY
Provider Middle Name:
ORVILLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1962590844
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12523 GREY FOX LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POTOMAC
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20854-1903
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-838-4258
Provider Business Mailing Address Fax Number:
301-838-4118

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9715 MEDICAL CENTER DR
Provider Second Line Business Practice Location Address:
SUITE 502
Provider Business Practice Location Address City Name:
ROCKVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20850-3320
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-279-0600
Provider Business Practice Location Address Fax Number:
301-294-5322
Provider Enumeration Date:
10/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  D41973 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 443098 . This is a "ALLIANCE/MAMSI" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 766551 . This is a "AETNA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 453691600 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 198776 . This is a "AMERIGROUP" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: F199 0001 . This is a "CAREFIRST BCBS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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