Provider Demographics
NPI:1285601658
Name:ROBERTS, THOMAS S (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:S
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 1:1850 RIDGE RD E
Mailing Address - Street 2:SUITE 11
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14622-2448
Mailing Address - Country:US
Mailing Address - Phone:585-336-9370
Mailing Address - Fax:
Practice Address - Street 1:1850 RIDGE RD E
Practice Address - Street 2:SUITE 11
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14622-2448
Practice Address - Country:US
Practice Address - Phone:585-336-9370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY160856207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP010160856OtherBLUE CHOICE
NY110158681OtherRAILROAD MEDICARE
NYIM/160856OtherWORKERS COMP
NY0466OtherBLUE SHIELD
NY1444866Medicaid
NYMDB812OtherPREFERRED CARE
NY4345415OtherAETNA
NYP010160856OtherBLUE CHOICE
NYB75842Medicare UPIN