Healthcare Provider Details

I. General information

NPI: 1104961788
Provider Name (Legal Business Name): BRETT D. ROBERTS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 07/05/2022
Certification Date: 07/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 STOCK ST STE 3
HANOVER PA
17331-2276
US

IV. Provider business mailing address

310 STOCK ST STE 3
HANOVER PA
17331-2276
US

V. Phone/Fax

Practice location:
  • Phone: 717-637-1738
  • Fax: 717-646-7430
Mailing address:
  • Phone: 717-637-1738
  • Fax: 717-646-7430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD448434
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberMD448434
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberD0073880
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: