Provider Demographics
NPI:1255813911
Name:ROBERTS, DAVID MCNEELY
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:MCNEELY
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:12070 OLD LINE CTR
Mailing Address - Street 2:STE 303
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-3535
Mailing Address - Country:US
Mailing Address - Phone:772-595-5302
Mailing Address - Fax:772-595-5304
Practice Address - Street 1:2401 FRIST BLVD STE 4
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950
Practice Address - Country:US
Practice Address - Phone:772-595-5302
Practice Address - Fax:772-595-5304
Is Sole Proprietor?:No
Enumeration Date:2018-08-29
Last Update Date:2021-06-04
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical