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NPI Code Detail

MEDICARE: JOHN ROBERTS ANP-BC

MEDICARE: JOHN ROBERTS ANP-BC
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
1363LA2200XAdult Health Nurse PractitionerRN153029MA

General Provider Information

NPI Number : 1558346296
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN ROBERTS ANP-BC
Provider Business Mailing Address
First Line : 55 DIMOCK ST
Second Line :
City : ROXBURY
State : MA
Zip : 02119-1029
Country : US
Telephone Number : 617-442-8800
Fax Number : 617-442-4088
Provider Business Practice Location Address
First Line : 45 DIMOCK ST
Second Line :
City : ROXBURY
State : MA
Zip : 02119-1208
Country : US
Telephone Number : 617-442-8800
Fax Number : 617-541-8472
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/14/2005
Last Update Date : 06/09/2022

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