Basic Information
| Provider Information | |||||||||
| NPI: | 1225031339 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROBERTS | ||||||||
| FirstName: | HERBERT | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 340 THOMAS MORE PKWY STE 260 | ||||||||
| Address2: | |||||||||
| City: | CRESTVIEW HILLS | ||||||||
| State: | KY | ||||||||
| PostalCode: | 410175117 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8599570700 | ||||||||
| FaxNumber: | 8599570703 | ||||||||
| Practice Location | |||||||||
| Address1: | 340 THOMAS MORE PKWY STE 260 | ||||||||
| Address2: | |||||||||
| City: | CRESTVIEW HILLS | ||||||||
| State: | KY | ||||||||
| PostalCode: | 410175117 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5989570700 | ||||||||
| FaxNumber: | 8599570703 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2005 | ||||||||
| LastUpdateDate: | 05/07/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | MD419284 | PA | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 208VP0014X | 52434 | KY | Y | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0019065450001 | 05 | PA | MEDICAID |