Provider Demographics
NPI:1104850171
Name:ABEYTA, ROBERTO B (MD)
Entity Type:Individual
Prefix:
First Name:ROBERTO
Middle Name:B
Last Name:ABEYTA
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 1:9 DUGWAY RD
Mailing Address - Street 2:
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-9819
Mailing Address - Country:US
Mailing Address - Phone:802-775-1158
Mailing Address - Fax:
Practice Address - Street 1:9 DUGWAY RD
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-9819
Practice Address - Country:US
Practice Address - Phone:802-775-1158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0420011703207P00000X
ME017953207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1104850171Medicaid
PA001441387Medicaid
ME001372701Medicare PIN
PAF73400Medicare UPIN
ME1104850171Medicaid