Provider Demographics
NPI:1083657522
Name:ROBERTS, JAMES WAYNE (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:WAYNE
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:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-343-9800
Mailing Address - Fax:704-347-2011
Practice Address - Street 1:1640 E ROOSEVELT BLVD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-4017
Practice Address - Country:US
Practice Address - Phone:704-226-0500
Practice Address - Fax:704-226-0599
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20005207RC0000X
NC9701857207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1087POtherBCBS
NCP00612335OtherRAILROAD MEDICARE
SCN01857Medicaid
NC891087PMedicaid
NCP00612335OtherRAILROAD MEDICARE
NCD92175Medicare UPIN
NC2248758EMedicare PIN
SCD921755332Medicare ID - Type Unspecified
SCD921757772Medicare PIN
NC2248758Medicare ID - Type Unspecified
SCN01857Medicaid