Individual
SUSAN DIANE ROBERTS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
131 JPM RD STE A, LEWISBURG, PA 17837-9309
(570) 523-6115
(570) 523-6178
Mailing address
7 DOCK HILL RD, MIDDLEBURG, PA 17842-8910
(570) 837-2123
(570) 837-2185
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
OA000816
PA
363AM0700X
Medical Physician Assistant
Primary
MA051057
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1031658940001
MEDICAID
PA
Enumeration date
06/06/2006
Last updated
10/05/2020
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