Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207SG0201X | Clinical Genetics (M.D.) | 1.034708 | CT |
NPI | 1578962478 |
---|---|
Provider Name | Dr. Michele Roberts |
First Address | Paxton, MA 01612-1569 |
Second Address | Paxton, MA 01612-1569 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2014 |
Last Update Date | 15/08/2014 |