Basic Information
Provider Information
NPI: 1326465329
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ROBERTS
FirstName: SARA
MiddleName: R.
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1 TIMBER LN
Address2:  
City: SOUTH BURLINGTON
State: VT
PostalCode: 054037205
CountryCode: US
TelephoneNumber: 8028474714
FaxNumber: 8028476333
Practice Location
Address1: 1 TIMBER LN
Address2:  
City: SOUTH BURLINGTON
State: VT
PostalCode: 054037205
CountryCode: US
TelephoneNumber: 8028474714
FaxNumber: 8028476333
Other Information
ProviderEnumerationDate: 03/27/2014
LastUpdateDate: 07/21/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000X042.0013841VTY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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