Provider Demographics
NPI:1073500385
Name:ROBERTS, WILLIAM D (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:D
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 1:101 ABBEYVILLE RD
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603-4603
Mailing Address - Country:US
Mailing Address - Phone:717-291-5991
Mailing Address - Fax:717-291-5806
Practice Address - Street 1:101 ABBEYVILLE RD
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-4603
Practice Address - Country:US
Practice Address - Phone:717-291-5991
Practice Address - Fax:717-291-5806
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2007-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD021360E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA443782OtherHIGHMARK BLUE SHIELD
PA01826601OtherCAPITAL BLUE CROSS
PA36544 S1QDOtherGEISINGER HEALTH PLAN
PAF46906OtherHEALTH ASSURANCE
PA0009431320001Medicaid
PA515158OtherAETNA HMO
PAP002634OtherGATEWAY HEALTH PLAN
PA5230031OtherAETNA NON-HMO
PAF46906OtherHEALTH ASSURANCE
PAF46906Medicare UPIN