Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 205670 | MA |
N | 111NI0900X | Internist | 205670 | MA |
N | 207RH0003X | Hematology & Oncology | 205670 | MA |
NPI | 1013929082 |
---|---|
Provider Name | Dr. Thomas G Roberts JR. |
First Address | Charlestown, MA 02129-9142 |
Second Address | Boston, MA 02114-2617 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2010232 | (05) | MA |
409654 | TUFTS HEALTH PLAN (01) | MA |
H85990 | (02) | |
J24720 | BCBS OF MA (01) | MA |