Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RX0202X | Medical Oncology | 14387R | LA |
Y | 207RX0202X | Medical Oncology | 159677 | MA |
NPI | 1003871336 |
---|---|
Provider Name | Todd F Roberts |
First Address | Fairhaven, MA 02719-5255 |
Second Address | Fairhaven, MA 02719-5208 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2006 |
Last Update Date | 08/02/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
009913476 | (05) | AL |
1108651 | (05) | LA |
H13911 | (02) | LA |