Provider Demographics
NPI:1477882736
Name:ROBERTS, JOANN B (PA-AA)
Entity Type:Individual
Prefix:MS
First Name:JOANN
Middle Name:B
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:PA-AA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6800 WILSON LN
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-4947
Mailing Address - Country:US
Mailing Address - Phone:301-915-4255
Mailing Address - Fax:
Practice Address - Street 1:6800 WILSON LN
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-4947
Practice Address - Country:US
Practice Address - Phone:301-915-4255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-16
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005744367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant