Provider Demographics
NPI:1992887491
Name:ROBERTS, JOHN D
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:D
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 208032
Mailing Address - Street 2:333 CEDAR STREET/MEDICAL ONCOLOGY
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06520-8032
Mailing Address - Country:US
Mailing Address - Phone:203-737-1600
Mailing Address - Fax:203-785-3788
Practice Address - Street 1:333 CEDAR STREET
Practice Address - Street 2:MEDICAL ONCOLOGY
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06520-8032
Practice Address - Country:US
Practice Address - Phone:203-737-1600
Practice Address - Fax:203-785-3788
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT051021207RH0003X
VA0101049631207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B73971Medicare UPIN
B73971Medicare UPIN
VA900000001Medicare PIN