Provider Demographics
NPI:1568558765
Name:ROBERTS, NILES M (MD)
Entity Type:Individual
Prefix:DR
First Name:NILES
Middle Name:M
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 E. CHESTNUT ST
Mailing Address - Street 2:SUITE 3A, PHYSIATRY ASSOCIATES, INC PS
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225
Mailing Address - Country:US
Mailing Address - Phone:414-964-5776
Mailing Address - Fax:
Practice Address - Street 1:800 E. CHESTNUT ST
Practice Address - Street 2:SUITE 3A, PHYSIATRY ASSOCIATES, INC PS
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225
Practice Address - Country:US
Practice Address - Phone:360-647-8359
Practice Address - Fax:360-738-9838
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI48927-020208100000X
WAMD60076501208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8550923Medicaid
WAG115143400Medicare PIN