Provider Demographics
NPI:1851357131
Name:ROBERTS, MARTIN (MD)
Entity Type:Individual
Prefix:
First Name:MARTIN
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 1:9 MAYFLOWER CT E
Mailing Address - Street 2:
Mailing Address - City:HOMOSASSA
Mailing Address - State:FL
Mailing Address - Zip Code:34446-4977
Mailing Address - Country:US
Mailing Address - Phone:352-476-2607
Mailing Address - Fax:
Practice Address - Street 1:900 EAST BROADWAY
Practice Address - Street 2:ST ALEXIUS HEALTH
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58506
Practice Address - Country:US
Practice Address - Phone:701-530-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2001-89207R00000X
NH10452207R00000X
FLME0088383207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30200030Medicaid
NHAA121351OtherHARVARD NH
FL274736700Medicaid
FL34097OtherBLUE SHIELD
NH01Y013580NH01OtherANTHEM BC BS
NMG1448Medicaid
FL34097ZMedicare ID - Type Unspecified
NM342412201Medicare ID - Type Unspecified
FL34097OtherBLUE SHIELD
NHAA121351OtherHARVARD NH