Provider Demographics
NPI:1578962478
Name:ROBERTS, MICHELE (MD PHD)
Entity Type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 HOWARD ST
Mailing Address - Street 2:
Mailing Address - City:PAXTON
Mailing Address - State:MA
Mailing Address - Zip Code:01612-1569
Mailing Address - Country:US
Mailing Address - Phone:508-752-8322
Mailing Address - Fax:
Practice Address - Street 1:44 HOWARD ST
Practice Address - Street 2:
Practice Address - City:PAXTON
Practice Address - State:MA
Practice Address - Zip Code:01612-1569
Practice Address - Country:US
Practice Address - Phone:508-752-8322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-15
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1.034708207SG0201X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology