Provider Demographics
NPI:1598863193
Name:ROBERTS, LAWRENCE (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7930 FROST ST STE 204
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-2739
Mailing Address - Country:US
Mailing Address - Phone:858-939-3200
Mailing Address - Fax:858-939-9213
Practice Address - Street 1:7930 FROST ST STE 204
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-2739
Practice Address - Country:US
Practice Address - Phone:858-939-3200
Practice Address - Fax:858-939-3213
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV215002086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3000211000Medicaid
WVRO6031822Medicare ID - Type Unspecified
WV3000211000Medicaid