MEDICARE: MICHAEL C. ROBERTS P.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	07495	MD

General Provider Information

NPI Number	:	1093856288
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL C. ROBERTS P.D.

Provider Business Mailing Address
First Line	:	703 GIDDINGS AVE
Second Line	:	SUITE L-1
City	:	ANNAPOLIS
State	:	MD
Zip	:	21401-1411
Country	:	US
Telephone Number	:	410-263-7440
Fax Number	:	410-269-5947

Provider Business Practice Location Address
First Line	:	703 GIDDINGS AVE
Second Line	:	SUITEW L-1
City	:	ANNAPOLIS
State	:	MD
Zip	:	21401-1411
Country	:	US
Telephone Number	:	410-263-7440
Fax Number	:	410-269-5947

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/09/2007
Last Update Date	:	07/08/2007

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