Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207L00000X | Anesthesiologist | MD465813 | PA |
NPI | 1003234196 |
---|---|
Provider Name | Monique Lorraine Roberts |
First Address | Philadelphia, PA 19140-5103 |
Second Address | Philadelphia, PA 19104-4238 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2014 |
Last Update Date | 25/05/2021 |