Provider Demographics
NPI:1750330759
Name:ROBERTO, PATRICK D (DPM)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:D
Last Name:ROBERTO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2402 STATE RTE 66
Mailing Address - Street 2:
Mailing Address - City:DELMONT
Mailing Address - State:PA
Mailing Address - Zip Code:15626-1464
Mailing Address - Country:US
Mailing Address - Phone:724-468-5368
Mailing Address - Fax:724-468-5388
Practice Address - Street 1:2402 STATE RTE 66
Practice Address - Street 2:
Practice Address - City:DELMONT
Practice Address - State:PA
Practice Address - Zip Code:15626-1464
Practice Address - Country:US
Practice Address - Phone:724-468-5368
Practice Address - Fax:724-468-5388
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2009-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC003807R213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA014407645Medicaid
U42397Medicare UPIN
746981LZZMedicare ID - Type Unspecified