Provider Demographics
NPI:1104262062
Name:ROBERTS, MARIA DOLORES (MD)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:DOLORES
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:DOLORES
Other - Last Name:ABASCAL-PONCIANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:201 SAINT ANN DR STE B
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70471-3472
Mailing Address - Country:US
Mailing Address - Phone:985-898-4001
Mailing Address - Fax:985-626-9618
Practice Address - Street 1:201 SAINT ANN DR STE B
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70471
Practice Address - Country:US
Practice Address - Phone:985-898-4001
Practice Address - Fax:985-626-9618
Is Sole Proprietor?:No
Enumeration Date:2013-05-20
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD53849207Q00000X
LA308242207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ022043Medicaid
TN103I081307Medicare PIN