Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 9701567 | NC |
NPI | 1053372888 |
---|---|
Provider Name | Dr. Lisa Marie Roberts |
First Address | Raleigh, NC 27614-6487 |
Second Address | Raleigh, NC 27614-6487 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2006 |
Last Update Date | 07/07/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H18104 | (02) | NC |