Provider Demographics
NPI:1003871336
Name:ROBERTS, TODD F (MD)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:F
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 MILL RD STE 180
Mailing Address - Street 2:
Mailing Address - City:FAIRHAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02719-5255
Mailing Address - Country:US
Mailing Address - Phone:508-973-2000
Mailing Address - Fax:508-973-2001
Practice Address - Street 1:206 MILL RD
Practice Address - Street 2:
Practice Address - City:FAIRHAVEN
Practice Address - State:MA
Practice Address - Zip Code:02719-5208
Practice Address - Country:US
Practice Address - Phone:508-973-3000
Practice Address - Fax:508-973-3119
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2013-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA14387R207RX0202X
MA159677207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009913476Medicaid
LA1108651Medicaid
LA4A877DB49Medicare PIN
LA4A877D867Medicare PIN
LA4A877CB84Medicare PIN
LA1108651Medicaid
LA4A877F818Medicare PIN