Provider Demographics
NPI:1548474638
Name:ROBERTS, PHILIP MICHAEL (DO)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:MICHAEL
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1735 27TH ST STE 206
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-2679
Mailing Address - Country:US
Mailing Address - Phone:740-354-7600
Mailing Address - Fax:740-354-7654
Practice Address - Street 1:1735 27TH ST STE 206
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-2679
Practice Address - Country:US
Practice Address - Phone:740-354-7600
Practice Address - Fax:740-354-7654
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34008800207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2742456Medicaid
OH2742456Medicaid
2028592Medicare Oscar/Certification