Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | 19815 | DC |
NPI | 1003918558 |
---|---|
Provider Name | James Curtis Roberson II |
First Address | Clinton, MD 20735-4220 |
Second Address | Clinton, MD 20735-4220 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/09/2006 |
Last Update Date | 30/09/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
46950033 | BCBS NCA (01) | |
521054342 | TRICARE (01) | |
52810102 | BCBS MARYLAND (01) | |
746631YZW | DC MEDICARE (01) | |
D0068136 | MARYLAND LICENSE # (01) | |
F57861 | (02) | DC |
P00887806 | RAILROAD MEDICARE INDIVIDUAL PTAN (01) |