Provider Demographics
NPI:1740508845
Name:ROBERTS, ANDREW P (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:P
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15719 CHILKAT TRL
Mailing Address - Street 2:
Mailing Address - City:HUNTERTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:46748-9220
Mailing Address - Country:US
Mailing Address - Phone:260-223-5611
Mailing Address - Fax:844-565-8144
Practice Address - Street 1:2121 LAKE AVE
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-5100
Practice Address - Country:US
Practice Address - Phone:260-426-5431
Practice Address - Fax:844-565-8144
Is Sole Proprietor?:No
Enumeration Date:2010-05-13
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01070597A208M00000X, 207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000001012413OtherANTHEM PROVIDER NUMBER
INP01824544OtherRR PTAN
IN201248640Medicaid
INP01671036Medicare PIN
IN201248640Medicaid
ININ2318007Medicare PIN