Provider Demographics
NPI:1700817251
Name:ROBERTS, KWANDAA MARIE (DO)
Entity Type:Individual
Prefix:DR
First Name:KWANDAA
Middle Name:MARIE
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 HUNTINGDON PIKE
Mailing Address - Street 2:SUITE 118
Mailing Address - City:MEADOWBROOK
Mailing Address - State:PA
Mailing Address - Zip Code:19046-8004
Mailing Address - Country:US
Mailing Address - Phone:215-914-2600
Mailing Address - Fax:215-938-9819
Practice Address - Street 1:1650 HUNTINGDON PIKE
Practice Address - Street 2:SUITE 118
Practice Address - City:MEADOWBROOK
Practice Address - State:PA
Practice Address - Zip Code:19046-8004
Practice Address - Country:US
Practice Address - Phone:215-914-2600
Practice Address - Fax:215-938-9819
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS013627207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology