Provider Demographics
NPI:1851419378
Name:ROBERTS, ROBERT EARL III (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:EARL
Last Name:ROBERTS
Suffix:III
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 1:1671 CROOKED OAK DR
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-4269
Mailing Address - Country:US
Mailing Address - Phone:717-569-5331
Mailing Address - Fax:717-569-4210
Practice Address - Street 1:1671 CROOKED OAK DR
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-4269
Practice Address - Country:US
Practice Address - Phone:717-569-5331
Practice Address - Fax:717-569-4210
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD430606208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102156863-0002Medicaid
PA102156863-0002Medicaid
PA102156863-0002Medicaid
SCAA47386672Medicare PIN