Provider Demographics
NPI:1104961788
Name:ROBERTS, BRETT D (MD)
Entity type:Individual
Prefix:
First Name:BRETT
Middle Name:D
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 1:310 STOCK ST STE 3
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17331-2276
Mailing Address - Country:US
Mailing Address - Phone:717-637-1738
Mailing Address - Fax:717-646-7430
Practice Address - Street 1:310 STOCK ST STE 3
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-2276
Practice Address - Country:US
Practice Address - Phone:717-637-1738
Practice Address - Fax:717-646-7430
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD448434207RC0001X, 207RC0000X
MDD0073880207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology