Provider Demographics
NPI:1164428363
Name:ROBERTS, DAYNE K (MD)
Entity Type:Individual
Prefix:DR
First Name:DAYNE
Middle Name:K
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2060
Mailing Address - Street 2:
Mailing Address - City:ALBEMARLE
Mailing Address - State:NC
Mailing Address - Zip Code:28002-2060
Mailing Address - Country:US
Mailing Address - Phone:704-983-0990
Mailing Address - Fax:704-983-6628
Practice Address - Street 1:301 YADKIN ST
Practice Address - Street 2:
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001-3441
Practice Address - Country:US
Practice Address - Phone:704-984-4385
Practice Address - Fax:704-983-5217
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2001012682085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC130CC2OtherBCBS OF NC
NC89130C2Medicaid
P00115961OtherRAILROAD MEDICARE
NC130CC2OtherBCBS OF NC
P00115961OtherRAILROAD MEDICARE