Healthcare Provider Details

I. General information

NPI: 1154320273
Provider Name (Legal Business Name): DAVID ROBERTS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 05/10/2024
Certification Date: 05/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 PONTIAC DR
MEDFORD NJ
08055-8146
US

IV. Provider business mailing address

6001 WEBB RD
TAMPA FL
33615-3241
US

V. Phone/Fax

Practice location:
  • Phone: 610-592-8235
  • Fax:
Mailing address:
  • Phone: 813-888-7060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number25MA07640500
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME165574
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: