Provider Demographics
NPI:1093700502
Name:ROBERTS, STUART L (MD)
Entity Type:Individual
Prefix:DR
First Name:STUART
Middle Name:L
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 1:36 TAMARACK AVE
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06811-4822
Mailing Address - Country:US
Mailing Address - Phone:203-739-7532
Mailing Address - Fax:203-796-7667
Practice Address - Street 1:24 HOSPITAL AVE
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-6099
Practice Address - Country:US
Practice Address - Phone:203-797-7322
Practice Address - Fax:203-796-7667
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0220872085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B38724Medicare UPIN
CT300000365Medicare PIN
CT300064467Medicare PIN
NY572T31Medicare PIN
CT300003627Medicare PIN
CTP00460843Medicare PIN
NY300136361Medicare PIN