Provider Demographics
NPI:1548592272
Name:ROBERTS, NATHAN SCOTT (DO)
Entity type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:SCOTT
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 1:2075 GLENN MITCHELL DR STE 512
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23456-0179
Mailing Address - Country:US
Mailing Address - Phone:757-507-8850
Mailing Address - Fax:
Practice Address - Street 1:2075 GLENN MITCHELL DR STE 512
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23456-0179
Practice Address - Country:US
Practice Address - Phone:757-507-8850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-05
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4951208600000X
PAOS021057208600000X
VA0102209063208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1528015401OtherHVMG
OK358315YM2YOtherMEDICARE
OK200305150BMedicaid