Provider Demographics
NPI:1033135108
Name:GROAT, ROBERT LANIER (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:LANIER
Last Name:GROAT
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 1:1317 N ELM ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-1033
Mailing Address - Country:US
Mailing Address - Phone:336-378-1442
Mailing Address - Fax:336-378-1970
Practice Address - Street 1:1317 N ELM ST
Practice Address - Street 2:SUITE 4
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1033
Practice Address - Country:US
Practice Address - Phone:336-378-1442
Practice Address - Fax:336-378-1970
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC19234207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1552894OtherCIGNA
NC19437OtherOPTICARE
NC37702OtherBLUE CROSS BLUE SHIELD
NC8937702Medicaid
NC0800177OtherUNITED HEALTHCARE OF NC
NC19437OtherOPTICARE
NC201531Medicare ID - Type Unspecified