Provider Demographics
NPI:1013964931
Name:ROBERTS, RITA SUE (DO)
Entity Type:Individual
Prefix:DR
First Name:RITA
Middle Name:SUE
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1735 27TH ST
Mailing Address - Street 2:WALLER BUILDING, SUITE 206
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-2677
Mailing Address - Country:US
Mailing Address - Phone:740-354-7600
Mailing Address - Fax:740-354-7654
Practice Address - Street 1:1735 27TH ST
Practice Address - Street 2:WALLER BUILDING, SUITE 206
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-2677
Practice Address - Country:US
Practice Address - Phone:740-354-7600
Practice Address - Fax:740-354-7654
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-008463207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2571837Medicaid
OHRO2027571Medicare PIN
OHI32830Medicare UPIN