Provider Demographics
NPI:1093828378
Name:HAWK, ROBERTA J (MD)
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:J
Last Name:HAWK
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1072 XRAY DR
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054
Mailing Address - Country:US
Mailing Address - Phone:704-671-1094
Mailing Address - Fax:704-671-1095
Practice Address - Street 1:649 N NEW HOPE RD
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-7424
Practice Address - Country:US
Practice Address - Phone:704-866-4005
Practice Address - Fax:704-866-0450
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2020-06-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC201802113207N00000X
LA016751207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNN4199AOtherNC MEDICARE
000011761OtherBLUE CROSS
NC2018-02113OtherNC MEDICAL LICENSE
260015882003OtherEBMS