Provider Demographics
NPI:1649386442
Name:ROBERTS, DEBRA L (MD)
Entity Type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:L
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 BAY SPRING AVE
Mailing Address - Street 2:B6
Mailing Address - City:BARRINGTON
Mailing Address - State:RI
Mailing Address - Zip Code:02806-1386
Mailing Address - Country:US
Mailing Address - Phone:401-338-3525
Mailing Address - Fax:404-698-2521
Practice Address - Street 1:60 BAY SPRING AVENUE
Practice Address - Street 2:6B
Practice Address - City:BARRINGTON
Practice Address - State:RI
Practice Address - Zip Code:02806-1386
Practice Address - Country:US
Practice Address - Phone:401-338-3525
Practice Address - Fax:404-698-2521
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD11566207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine