Healthcare Provider Details

I. General information

NPI: 1023025418
Provider Name (Legal Business Name): JAMES W ROBERTS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 08/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 ALLEN ST
RUTLAND VT
05701-4560
US

IV. Provider business mailing address

160 ALLEN ST
RUTLAND VT
05701-4560
US

V. Phone/Fax

Practice location:
  • Phone: 802-775-7111
  • Fax: 802-747-6260
Mailing address:
  • Phone: 802-775-7111
  • Fax: 802-747-6260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number0420010108
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: