Provider Demographics
NPI:1376516997
Name:ROBERTO, LINDA M (MNT)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:M
Last Name:ROBERTO
Suffix:
Gender:F
Credentials:MNT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 E MORELAND AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19118-3541
Mailing Address - Country:US
Mailing Address - Phone:267-385-5538
Mailing Address - Fax:267-437-3176
Practice Address - Street 1:10 E MORELAND AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19118-3541
Practice Address - Country:US
Practice Address - Phone:267-385-5538
Practice Address - Fax:267-437-3176
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2012-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN000560133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA086840E1EMedicare ID - Type Unspecified