Healthcare Provider Details

I. General information

NPI: 1396735429
Provider Name (Legal Business Name): R MICHAEL ROBERTS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2005
Last Update Date: 09/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 EWING ST A-8
PRINCETON NJ
08540-2757
US

IV. Provider business mailing address

601 EWING ST A-8
PRINCETON NJ
08540-2757
US

V. Phone/Fax

Practice location:
  • Phone: 609-921-6555
  • Fax: 609-924-5911
Mailing address:
  • Phone: 609-921-6555
  • Fax: 609-924-5911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number25MA02945000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: