Provider Demographics
NPI:1326007386
Name:ROBERTS, AMY B (MD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:B
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1327
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:VT
Mailing Address - Zip Code:05495-1327
Mailing Address - Country:US
Mailing Address - Phone:802-524-7100
Mailing Address - Fax:802-524-7021
Practice Address - Street 1:77 FAIRFIELD ST
Practice Address - Street 2:
Practice Address - City:ST ALBANS
Practice Address - State:VT
Practice Address - Zip Code:05478-1716
Practice Address - Country:US
Practice Address - Phone:802-524-5617
Practice Address - Fax:802-524-3216
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VT042-0009109207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0VN1169Medicaid
VT0VN1169Medicaid
F79500Medicare UPIN