Basic Information
| Provider Information | |||||||||
| NPI: | 1316933005 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROBERTS | ||||||||
| FirstName: | BLAIR | ||||||||
| MiddleName: | COOKE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 70 EAST STREET | ||||||||
| Address2: | MFHC | ||||||||
| City: | METHUEN | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018050001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9786833491 | ||||||||
| FaxNumber: | 9786833058 | ||||||||
| Practice Location | |||||||||
| Address1: | 70 EAST STREET | ||||||||
| Address2: | MFHC | ||||||||
| City: | METHUEN | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018050001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9786833491 | ||||||||
| FaxNumber: | 9786833058 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2005 | ||||||||
| LastUpdateDate: | 05/04/2016 | ||||||||
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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 | 207Q00000X | 73104 | MA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.