Provider Demographics
NPI:1669448130
Name:ROBERTS, CAROL A (NP)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:A
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:50 TREMONT ST
Mailing Address - Street 2:#109
Mailing Address - City:MELROSE
Mailing Address - State:MA
Mailing Address - Zip Code:02176-2721
Mailing Address - Country:US
Mailing Address - Phone:781-662-3310
Mailing Address - Fax:781-662-6403
Practice Address - Street 1:50 TREMONT ST
Practice Address - Street 2:#109
Practice Address - City:MELROSE
Practice Address - State:MA
Practice Address - Zip Code:02176-2721
Practice Address - Country:US
Practice Address - Phone:781-662-3310
Practice Address - Fax:781-662-6403
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2011-07-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA133033363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAS44375Medicare UPIN