Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 0000-24096 | NC |
NPI | 1093759243 |
---|---|
Provider Name | Richard S Roberts |
First Address | Charlotte, NC 28263-3376 |
Second Address | Charlotte, NC 28204-4375 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2006 |
Last Update Date | 26/10/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02184 | BCBS (01) | NC |
8972230 | (05) | NC |
C82554 | (02) | |
N24096 | (05) | SC |