Provider Demographics
NPI:1487652145
Name:ROBERTS, KEITH M (MD)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:M
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:8580 MAGELLAN PKWY
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23227-1149
Mailing Address - Country:US
Mailing Address - Phone:804-765-5206
Mailing Address - Fax:804-765-5809
Practice Address - Street 1:439 JENNICK DR
Practice Address - Street 2:
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834-4901
Practice Address - Country:US
Practice Address - Phone:804-765-5206
Practice Address - Fax:804-765-5809
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101056303207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6208797Medicaid
VA6208797Medicaid
VAH17605Medicare UPIN
VA541941044OtherEIN
VA160001741Medicare PIN