Provider Demographics
NPI:1336553395
Name:ROBERTS, VIRGINIA MAY (MD)
Entity Type:Individual
Prefix:DR
First Name:VIRGINIA
Middle Name:MAY
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 ALBANY STREET, SHAPIRO 5 & 6
Mailing Address - Street 2:BOSTON MEDICAL CENTER
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2526
Mailing Address - Country:US
Mailing Address - Phone:617-414-5951
Mailing Address - Fax:617-414-9251
Practice Address - Street 1:725 ALBANY STREET, SHAPIRO 5 & 6
Practice Address - Street 2:BOSTON MEDICAL CENTER
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2526
Practice Address - Country:US
Practice Address - Phone:617-414-5951
Practice Address - Fax:617-414-9251
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-18
Last Update Date:2015-02-23
Deactivation Date:2015-01-20
Deactivation Code:
Reactivation Date:2015-02-23
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program