Provider Demographics
NPI:1366467508
Name:ROBERTS, KAREN L (DO)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:L
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 OCEAN AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-4973
Mailing Address - Country:US
Mailing Address - Phone:207-541-9285
Mailing Address - Fax:207-773-7340
Practice Address - Street 1:535 OCEAN AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-4973
Practice Address - Country:US
Practice Address - Phone:207-541-9285
Practice Address - Fax:207-773-7340
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1838207Q00000X, 204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME413520099Medicaid
MEP01046692Medicare PIN
MEME090701Medicare PIN
ME201801Medicare Oscar/Certification
MEP01030339Medicare PIN
ME413520099Medicaid
MEMM2976Medicare PIN
MEME090702Medicare PIN
ME201802Medicare Oscar/Certification
MEME090704Medicare PIN
MEME090703Medicare PIN