Provider Demographics
NPI:1184650012
Name:ROBERTS, LEANNE (NP)
Entity Type:Individual
Prefix:
First Name:LEANNE
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 CUMMINGS CTR
Mailing Address - Street 2:SUITE 126V
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-6198
Mailing Address - Country:US
Mailing Address - Phone:978-279-0800
Mailing Address - Fax:978-279-0805
Practice Address - Street 1:900 CUMMINGS CTR
Practice Address - Street 2:SUITE 126V
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-6198
Practice Address - Country:US
Practice Address - Phone:978-279-0800
Practice Address - Fax:978-279-0805
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA232009363L00000X, 207Q00000X
NH046907-23363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0380580Medicaid
MANP3168OtherBLUE CROSS BLUE SHIELD
NHP29037Medicare UPIN
NP3168Medicare ID - Type Unspecified
NH000890301Medicare PIN
MA0380580Medicaid