Provider Demographics
NPI:1295739621
Name:ROBERTS, MAUREEN
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3050 ROUTE 50 STE 201
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-2906
Mailing Address - Country:US
Mailing Address - Phone:518-584-4426
Mailing Address - Fax:
Practice Address - Street 1:3050 ROUTE 50 STE 201
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-2906
Practice Address - Country:US
Practice Address - Phone:518-584-4426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-13
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY173803-1207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY15650OtherMVP
NY10031093OtherCDPHP
NY51Z301OtherBLUE CROSS
NY000491944002OtherBLUE SHIELD
NY040426007106OtherFIDELIS
NY000491944002OtherBLUE SHIELD
NY10031093OtherCDPHP
NY51Z301OtherBLUE CROSS