Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 1838 | ME |
N | 207Q00000X | Family Doctor | 1838 | ME |
NPI | 1366467508 |
---|---|
Provider Name | Karen L Roberts |
First Address | Portland, ME 04103-4973 |
Second Address | Portland, ME 04103-4973 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2006 |
Last Update Date | 23/07/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
413520099 | (05) | ME |
I16260 | (02) |