Provider Demographics
NPI:1316236300
Name:ROBERTS, SUZANNE G (MD)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:G
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:
Other - Last Name:GRONDIN ROBERTS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:BIDDEFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04005-9422
Mailing Address - Country:US
Mailing Address - Phone:207-282-9080
Mailing Address - Fax:207-934-0465
Practice Address - Street 1:1 GRANNY SMITH COURT
Practice Address - Street 2:
Practice Address - City:OLD ORCHARD BEACH
Practice Address - State:ME
Practice Address - Zip Code:04064
Practice Address - Country:US
Practice Address - Phone:207-934-7276
Practice Address - Fax:207-934-0465
Is Sole Proprietor?:No
Enumeration Date:2011-03-31
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD15516207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1316236300Medicaid
ME002878401Medicare PIN