MEDICARE: DR. DAVID ROBERTS MD

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	2085R0202X	Diagnostic Radiology Physician	25MA07640500	NJ
2	2085R0202X	Diagnostic Radiology Physician	ME165574	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	P00200867	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	A3738029	OTHER	OXFORD HEALTH
3	11180686	OTHER	CAQH
5	RO1653259	OTHER	PREMIER BLUE
6	1124410	OTHER	AETNA
7	1653259	OTHER	HIGHMARK PA BLUE SHIELD
8	2329848000	OTHER	AMERIHEALTH
9	60011009	OTHER	HORIZON NJ HEALTH

General Provider Information

NPI Number	:	1154320273
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID ROBERTS MD

Provider Business Mailing Address
First Line	:	6001 WEBB RD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33615-3241
Country	:	US
Telephone Number	:	813-888-7060
Fax Number	:

Provider Business Practice Location Address
First Line	:	37 PONTIAC DR
Second Line	:
City	:	MEDFORD
State	:	NJ
Zip	:	08055-8146
Country	:	US
Telephone Number	:	610-592-8235
Fax Number	:

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

Provider Enumeration Date	:	07/20/2005
Last Update Date	:	05/10/2024

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Directions to “ DR. DAVID ROBERTS MD” Practice Location

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