Provider Demographics
NPI:1245215037
Name:PORTELA, ROBERTO CARLOS (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERTO
Middle Name:CARLOS
Last Name:PORTELA
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:PO BOX 751069
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1069
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2100 STANTONSBURG RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-2818
Practice Address - Country:US
Practice Address - Phone:252-744-4757
Practice Address - Fax:252-744-4125
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR15720207P00000X
NC2013-01711207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1245215037Medicaid
NC1824NOtherBCBS NC
NY295964OtherMEDICAL LICENSE