Healthcare Provider Details

I. General information

NPI: 1992887491
Provider Name (Legal Business Name): DR. JOHN D ROBERTS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 02/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 CEDAR STREET MEDICAL ONCOLOGY
NEW HAVEN CT
06520-8032
US

IV. Provider business mailing address

PO BOX 208032 333 CEDAR STREET/MEDICAL ONCOLOGY
NEW HAVEN CT
06520-8032
US

V. Phone/Fax

Practice location:
  • Phone: 203-737-1600
  • Fax: 203-785-3788
Mailing address:
  • Phone: 203-737-1600
  • Fax: 203-785-3788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number051021
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: