Provider Demographics
NPI:1467557793
Name:PERSAUD, ROBERTA (MD)
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:
Last Name:PERSAUD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29099 HEALTH CAMPUS DR
Mailing Address - Street 2:BLDG 3 SUITE 120
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145
Mailing Address - Country:US
Mailing Address - Phone:440-835-6169
Mailing Address - Fax:440-892-6514
Practice Address - Street 1:29099 HEALTH CAMPUS DR
Practice Address - Street 2:BLDG 3 SUITE 120
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145
Practice Address - Country:US
Practice Address - Phone:440-835-6169
Practice Address - Fax:440-892-6514
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH055451207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0744467Medicaid
OH0744467Medicaid
E33916Medicare UPIN