Provider Demographics
NPI:1144228024
Name:ROBERTS, MICHAEL DON (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DON
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 1:600 18TH ST STE 401
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26101-3236
Mailing Address - Country:US
Mailing Address - Phone:304-865-4350
Mailing Address - Fax:304-865-4348
Practice Address - Street 1:800 GRAND CENTRAL MALL
Practice Address - Street 2:SUITE 2
Practice Address - City:VIENNA
Practice Address - State:WV
Practice Address - Zip Code:26105-4100
Practice Address - Country:US
Practice Address - Phone:304-865-4350
Practice Address - Fax:304-420-5995
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV17368208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV311599387005OtherMOUNTAIN STATE BCBS
WVWV17368OtherHEALTH PLAN
298185OtherMAMSI
WV0048334000Medicaid
OH2055565Medicaid
WV5880656OtherAETNA
RO4231681Medicare PIN
298185OtherMAMSI
WV311599387005OtherMOUNTAIN STATE BCBS
OH2055565Medicaid