Provider Demographics
NPI:1548592272
Name:ROBERTS, NATHAN (DO)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 BROAD ST STE 411
Mailing Address - Street 2:
Mailing Address - City:SEWICKLEY
Mailing Address - State:PA
Mailing Address - Zip Code:15143-1670
Mailing Address - Country:US
Mailing Address - Phone:724-773-6400
Mailing Address - Fax:
Practice Address - Street 1:701 BROAD ST STE 411
Practice Address - Street 2:
Practice Address - City:SEWICKLEY
Practice Address - State:PA
Practice Address - Zip Code:15143-1670
Practice Address - Country:US
Practice Address - Phone:724-773-6400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-05
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4951208600000X
PAOS021057208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200305150BMedicaid
PA1528015401OtherHVMG
OK358315YM2YOtherMEDICARE