Provider Demographics
NPI:1083640023
Name:ROESHMAN, ROBERT M (D O)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:M
Last Name:ROESHMAN
Suffix:
Gender:M
Credentials:D O
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4542 GAME PRESERVE RD
Mailing Address - Street 2:
Mailing Address - City:SCHNECKSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18078-2303
Mailing Address - Country:US
Mailing Address - Phone:610-360-4191
Mailing Address - Fax:610-360-4191
Practice Address - Street 1:4542 GAME PRESERVE RD
Practice Address - Street 2:
Practice Address - City:SCHNECKSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18078-2303
Practice Address - Country:US
Practice Address - Phone:610-360-4191
Practice Address - Fax:610-360-4191
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-23
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS003344L2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
424873Medicare ID - Type Unspecified
PAB34938Medicare UPIN