Provider Demographics
NPI:1700878139
Name:ROBERTS, MATTHEW A (DO)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:A
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 1:6845 MOUNTAIN VIEW RD
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6561
Mailing Address - Country:US
Mailing Address - Phone:423-910-0896
Mailing Address - Fax:423-910-1183
Practice Address - Street 1:6845 MOUNTAIN VIEW RD
Practice Address - Street 2:
Practice Address - City:OOLTEWAH
Practice Address - State:TN
Practice Address - Zip Code:37363-6561
Practice Address - Country:US
Practice Address - Phone:423-910-0896
Practice Address - Fax:423-910-1183
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2016-06-23
Deactivation Date:2006-03-27
Deactivation Code:
Reactivation Date:2006-04-07
Provider Licenses
StateLicense IDTaxonomies
TNDO000938207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3302990Medicare PIN
GA16BBCKJMedicare PIN