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1669463279

NPI Code Detail

MEDICARE: DR. ANGELA DEROBERTIS MD

MEDICARE: DR. ANGELA DEROBERTIS 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
1	2085R0001X	Radiation Oncology Physician	13785	RI
2	2085R0001X	Radiation Oncology Physician	223387	MA
3	2085R0001X	Radiation Oncology Physician	MD066735L	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P01332041	OTHER	RI	RR MEDICARE
4	P01334694	OTHER	RI	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	J28326	OTHER	MA	BCBS MA
5	470043	OTHER	MA	TUFTS HEALTH PLAN
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	8983518	OTHER	RI	CIGNA
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669463279
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANGELA DEROBERTIS MD

Provider Business Mailing Address
First Line	:	1703 INNOVATION DR STE 100
Second Line	:
City	:	YORK
State	:	PA
Zip	:	17408-8815
Country	:	US
Telephone Number	:	717-801-0742
Fax Number	:

Provider Business Practice Location Address
First Line	:	1703 INNOVATION DR STE 100
Second Line	:
City	:	YORK
State	:	PA
Zip	:	17408-8815
Country	:	US
Telephone Number	:	717-801-0742
Fax Number	:

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

Provider Enumeration Date	:	11/02/2005
Last Update Date	:	02/15/2022

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Practice Location Address:

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Practice Location Address:

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1184605677 — DR. GREGORY S WILLIS DO
Practice Location Address:

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Directions to “ DR. ANGELA DEROBERTIS MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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