Provider Demographics
NPI:1396771424
Name:DEROBERTS, DEAN (MD)
Entity type:Individual
Prefix:
First Name:DEAN
Middle Name:
Last Name:DEROBERTS
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 1:3107 E GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13224-1646
Mailing Address - Country:US
Mailing Address - Phone:315-299-5313
Mailing Address - Fax:315-299-5616
Practice Address - Street 1:3107 E GENESEE ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13224-1646
Practice Address - Country:US
Practice Address - Phone:315-299-5313
Practice Address - Fax:315-299-5661
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME95604208200000X
NY256232208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery