| Doctor Name: | DR. MIGUEL EDUARDO ROBERTS |
| NPI Number: | 1073653044 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PH.D. |
| License Number: | 102685 |
| Business Practice Address: | Perry Point Va Medical Center Building 364, Rm C108 Perry Point, MD - 21902 |
| Business Phone Number: | 4106422411 |
| Business Fax Number: | |
| Mailing Address: | 1004 Hickam Rd, BALTIMORE |
| State: | MD |
| Postal Code: | 212203700 |
| Phone Number: | 4106422411 |
| Fax Number: | |
| NPI Enumeration Date: | 02/07/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 102685 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NC |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |