Healthcare Provider Details

I. General information

NPI: 1306040217
Provider Name (Legal Business Name): TERESA L ROBERTS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 04/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MICHIGAN AVE NW
WASHINGTON DC
20010-2916
US

IV. Provider business mailing address

PO BOX 37215
BALTIMORE MD
21297-3215
US

V. Phone/Fax

Practice location:
  • Phone: 202-476-2025
  • Fax: 202-476-5999
Mailing address:
  • Phone: 202-476-2025
  • Fax: 202-476-5999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number0101241276
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD038143
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: