Provider Demographics
NPI:1841285582
Name:PALESTINE, ROBERTA F (MD)
Entity type:Individual
Prefix:
First Name:ROBERTA
Middle Name:F
Last Name:PALESTINE
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 1:6410 ROCKLEDGE DR
Mailing Address - Street 2:STE 201
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-1809
Mailing Address - Country:US
Mailing Address - Phone:301-530-8300
Mailing Address - Fax:301-530-4638
Practice Address - Street 1:6410 ROCKLEDGE DR
Practice Address - Street 2:STE 201
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-1809
Practice Address - Country:US
Practice Address - Phone:301-530-8300
Practice Address - Fax:301-530-4638
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-20
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0027831207N00000X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD567739Medicare ID - Type Unspecified
B96132Medicare UPIN