Provider Demographics
NPI:1376591743
Name:ROBERTS, NANCY SUE (MD)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:SUE
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:SUE
Other - Last Name:ROBERTS-REED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:100 E LANCASTER AVE
Mailing Address - Street 2:353 MEDICAL OFFICE BUILDING EAST
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-3450
Mailing Address - Country:US
Mailing Address - Phone:610-649-9021
Mailing Address - Fax:610-649-8058
Practice Address - Street 1:100 E LANCASTER AVE
Practice Address - Street 2:353 MEDICAL OFFICE BUILDING EAST
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-3450
Practice Address - Country:US
Practice Address - Phone:610-649-9021
Practice Address - Fax:610-649-8058
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD019562E207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0052930000OtherBC/BS KEYSTONE, PERSONAL
PA149436OtherBC/BS SHIELD HIGHMARK
PA30018991OtherKEYSTONE MERCY
PA33657OtherHEALTH PARTNERS
PA33658OtherHEALTH PARTNERS
PA3716959OtherAETNA US HEALTHCARE GROUP
PA2330386000OtherBC/BS KEY, PER. GROUP
PA33659OtherHEALTH PARTNERS
PA001055531Medicaid
PA0105553107OtherAMERICHOICE
PA30018989OtherKEYSTONE MERCY GROUP
PA4092729OtherAETNA US HEALTHCARE
PA1652891OtherBC/BS HIGHMARK GROUP
PA02640OtherHEALTH PARTNERS
PA3716970OtherAETNA US HEALTHCARE HMO
PA3716959OtherAETNA US HEALTHCARE GROUP
PA30018991OtherKEYSTONE MERCY
PA802212TGWMedicare PIN