Provider Demographics
NPI:1962590844
Name:ROBERTS, ANTHONY ORVILLE (MD)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:ORVILLE
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 1:12523 GREY FOX LN
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-1903
Mailing Address - Country:US
Mailing Address - Phone:301-838-4258
Mailing Address - Fax:301-838-4118
Practice Address - Street 1:9715 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 502
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3320
Practice Address - Country:US
Practice Address - Phone:301-279-0600
Practice Address - Fax:301-294-5322
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD41973207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD443098OtherALLIANCE/MAMSI
MD766551OtherAETNA
MD453691600Medicaid
MD198776OtherAMERIGROUP
MDF199 0001OtherCAREFIRST BCBS
MD198776OtherAMERIGROUP
MD766551OtherAETNA