Michael Roberson

Primary specialty

Peer SpecialistTaxonomy code 175T00000X

License

0735001041 Issued in VA

Practice address

3974 Springfield Rd
Glen Allen, VA 23060-4119

Phone

(804) 495-8661

Fax

(804) 486-9819

NPI assigned

Oct 25, 2024

Last updated

Oct 25, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1729814400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729814400000",
    "number": "1629890272",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3974 SPRINGFIELD RD",
            "city": "GLEN ALLEN",
            "state": "VA",
            "postal_code": "230604119",
            "telephone_number": "804-495-8661",
            "fax_number": "804-486-9819"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3974 SPRINGFIELD RD",
            "city": "GLEN ALLEN",
            "state": "VA",
            "postal_code": "230604119",
            "telephone_number": "804-495-8661",
            "fax_number": "804-486-9819"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERSON",
        "first_name": "MICHAEL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-10-25",
        "last_updated": "2024-10-25",
        "certification_date": "2024-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": "VA",
            "license": "0735001041",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Peer Specialist in Glen Allen, VA
• Providers in Glen Allen, VA by specialty
• Peer Specialist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.