Provider Demographics
NPI:1962450023
Name:ROBERTI, FABIO (MD)
Entity Type:Individual
Prefix:
First Name:FABIO
Middle Name:
Last Name:ROBERTI
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 1:1000 36TH ST
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-4862
Mailing Address - Country:US
Mailing Address - Phone:772-563-4741
Mailing Address - Fax:772-563-4646
Practice Address - Street 1:3450 11TH CT STE 301
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-5012
Practice Address - Country:US
Practice Address - Phone:772-563-4741
Practice Address - Fax:772-563-4646
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101241128207T00000X
WAMD00045863207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
06189961OtherECFMG NUMBER
FL003476000Medicaid
FL003476000Medicaid
021545M83Medicare PIN
FLEZ265ZMedicare PIN