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General NPI Number Information
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NPI Number | 1154320273
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Entity Type | Individual
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Provider Name | DAVID ROBERTS MD
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Gender | Male
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Dates
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Enumeration Date | 07/20/2005
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Last Update Date | 05/10/2024
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Provider Practice Location Address
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Address Line | 37 PONTIAC DR
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City | MEDFORD
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State | NJ
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Zip | 08055-8146
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Country | US
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Telephone | 610-592-8235
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Fax |
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Provider Business Mailing Address
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Address Line | 6001 WEBB RD
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City | TAMPA
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State | FL
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Zip | 33615-3241
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Country | US
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Telephone | 813-888-7060
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 25MA07640500
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | ME165574
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License Number State | FL
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