Healthcare Provider Details

I. General information

NPI: 1346777869
Provider Name (Legal Business Name): MADELEINE CLAIRE ROBERTS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2017
Last Update Date: 03/13/2024
Certification Date: 03/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7619 LITTLE RIVER TPKE
ANNANDALE VA
22003-2646
US

IV. Provider business mailing address

4001 VOLLMER RD
OLYMPIA FIELDS IL
60461-3168
US

V. Phone/Fax

Practice location:
  • Phone: 703-256-5680
  • Fax:
Mailing address:
  • Phone: 708-481-8883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberTL0006769
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036.154256
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101279690
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: