Provider Demographics
NPI:1487743381
Name:ROBERTS, MARY LINDA (MD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:LINDA
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:960 HEACOCK AVE
Mailing Address - Street 2:
Mailing Address - City:PACIFIC GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:93950-2429
Mailing Address - Country:US
Mailing Address - Phone:831-655-1225
Mailing Address - Fax:
Practice Address - Street 1:3401 ENGINEER LN
Practice Address - Street 2:
Practice Address - City:SEASIDE
Practice Address - State:CA
Practice Address - Zip Code:93955-7200
Practice Address - Country:US
Practice Address - Phone:831-883-3820
Practice Address - Fax:831-883-3829
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA150745207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00000Medicare UPIN