Provider Demographics
NPI:1013467406
Name:ROBERTS, ELIZABETH ANN (PA-C)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANN
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:111 ROBERTS RD STE 200
Mailing Address - Street 2:
Mailing Address - City:GRINDSTONE
Mailing Address - State:PA
Mailing Address - Zip Code:15442-1105
Mailing Address - Country:US
Mailing Address - Phone:724-785-2286
Mailing Address - Fax:724-785-3187
Practice Address - Street 1:111 ROBERTS RD STE 200
Practice Address - Street 2:
Practice Address - City:GRINDSTONE
Practice Address - State:PA
Practice Address - Zip Code:15442-1105
Practice Address - Country:US
Practice Address - Phone:724-785-2286
Practice Address - Fax:724-785-3187
Is Sole Proprietor?:No
Enumeration Date:2016-10-10
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA058454363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant