Provider Demographics
NPI:1114923679
Name:ROBERTS, LEE ANN (MD)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:ANN
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5816 CREEDMOOR RD
Mailing Address - Street 2:STE 209
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-2310
Mailing Address - Country:US
Mailing Address - Phone:919-881-7766
Mailing Address - Fax:919-881-0779
Practice Address - Street 1:5816 CREEDMOOR RD
Practice Address - Street 2:STE 209
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-2310
Practice Address - Country:US
Practice Address - Phone:919-881-7766
Practice Address - Fax:919-881-0779
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC29381207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
C86831Medicare UPIN
203720BMedicare ID - Type Unspecified