Provider Demographics
NPI:1720052558
Name:ROBERTS, WILLIAM H (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:H
Last Name:ROBERTS
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 1:5100 W TAFT RD
Mailing Address - Street 2:SUITE 4-D
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088-3807
Mailing Address - Country:US
Mailing Address - Phone:315-458-6669
Mailing Address - Fax:315-458-0819
Practice Address - Street 1:5100 W TAFT RD
Practice Address - Street 2:SUITE 4-D
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13088-3807
Practice Address - Country:US
Practice Address - Phone:315-458-6669
Practice Address - Fax:315-458-0819
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY118949208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00536461Medicaid
NY00536461Medicaid
D75382Medicare UPIN