MEDICARE: PAUL JOHN ROBERTO 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	208800000X	Urology Physician	0101057462	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952305989
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL JOHN ROBERTO MD

Provider Business Mailing Address
First Line	:	6055 HARBOUR PARK DRIVE
Second Line	:
City	:	MIDLOTHIAN
State	:	VA
Zip	:	23112-2160
Country	:	US
Telephone Number	:	804-639-7777
Fax Number	:	804-823-2720

Provider Business Practice Location Address
First Line	:	6055 HARBOUR PARK DRIVE
Second Line	:
City	:	MIDLOTHIAN
State	:	VA
Zip	:	23112-2160
Country	:	US
Telephone Number	:	804-639-7777
Fax Number	:	804-823-2720

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

Provider Enumeration Date	:	06/08/2005
Last Update Date	:	10/07/2016

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