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NPI Code Detail

MEDICARE: THOM R ROBERTS MD

MEDICARE: THOM R ROBERTS MD
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
1208000000XPediatrics PhysicianMD014639EPA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1053314781
Entity Type Code : Individual
Provider Name (Legal Business Name) : THOM R ROBERTS MD
Provider Business Mailing Address
First Line : 11279 PERRY HWY
Second Line : STE 450
City : WEXFORD
State : PA
Zip : 15090-9303
Country : US
Telephone Number : 724-933-1100
Fax Number : 724-933-1160
Provider Business Practice Location Address
First Line : 1600 CORAOPOLIS HEIGHTS RD
Second Line : STE E
City : MOON TWP
State : PA
Zip : 15108-4316
Country : US
Telephone Number : 412-262-2415
Fax Number : 412-262-1537
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/26/2005
Last Update Date : 03/24/2010

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