Provider Demographics
NPI:1053421511
Name:ROBERTS, THOMAS SCOTT (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:SCOTT
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 MEDICAL PL
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:IN
Mailing Address - Zip Code:47274-2640
Mailing Address - Country:US
Mailing Address - Phone:812-519-1552
Mailing Address - Fax:812-519-1774
Practice Address - Street 1:1130 MEDICAL PL
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:IN
Practice Address - Zip Code:47274-2640
Practice Address - Country:US
Practice Address - Phone:812-519-1552
Practice Address - Fax:812-519-1774
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01034569A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100140640AMedicaid
ING19215Medicare UPIN
IN100140640AMedicaid