Provider Demographics
NPI:1982625075
Name:MCROBERTS, MARTIN L (MD)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:L
Last Name:MCROBERTS
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 1:602 E. 72ND STREET
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-4913
Mailing Address - Country:US
Mailing Address - Phone:912-819-7878
Mailing Address - Fax:912-819-5044
Practice Address - Street 1:410 MALL BLVD.
Practice Address - Street 2:SUITE E
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-4869
Practice Address - Country:US
Practice Address - Phone:912-352-7194
Practice Address - Fax:912-352-3131
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA026330207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA08BBRHHOtherMEDICARE
GA000284754DMedicaid
GAB50668Medicare UPIN
GA000284754DMedicaid