Provider Demographics
NPI:1225031339
Name:ROBERTS, HERBERT R (MD)
Entity Type:Individual
Prefix:
First Name:HERBERT
Middle Name:R
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 1:340 THOMAS MORE PKWY STE 260
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW HILLS
Mailing Address - State:KY
Mailing Address - Zip Code:41017-5117
Mailing Address - Country:US
Mailing Address - Phone:859-957-0700
Mailing Address - Fax:859-957-0703
Practice Address - Street 1:340 THOMAS MORE PKWY STE 260
Practice Address - Street 2:
Practice Address - City:CRESTVIEW HILLS
Practice Address - State:KY
Practice Address - Zip Code:41017-5117
Practice Address - Country:US
Practice Address - Phone:598-957-0700
Practice Address - Fax:859-957-0703
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2019-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD419284207V00000X
KY52434208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019065450001Medicaid
PA598079Medicare PIN
PA0019065450001Medicaid