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General NPI Number Information
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NPI Number | 1316904121
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Entity Type | Individual
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Provider Name | BONNI ROBERTS DO
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Gender | Female
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Dates
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Enumeration Date | 04/26/2006
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Last Update Date | 05/05/2008
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Provider Practice Location Address
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Address Line | 361 FAIR HILL DR
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City | ELKTON
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State | MD
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Zip | 21921-2512
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Country | US
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Telephone | 410-620-7260
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Fax | 410-620-7262
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Provider Business Mailing Address
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Address Line | PO BOX 190
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City | ELKTON
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State | MD
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Zip | 21922-0190
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Country | US
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Telephone | 410-398-4679
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Fax | 410-620-3686
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | H0062851
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | C2-0007295
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License Number State | DE
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