Provider Demographics
NPI:1376521831
Name:ROBERTS, JOAN THERESE (MD)
Entity Type:Individual
Prefix:DR
First Name:JOAN
Middle Name:THERESE
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4102 N ROXBORO ST
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-2122
Mailing Address - Country:US
Mailing Address - Phone:919-595-2000
Mailing Address - Fax:919-595-2190
Practice Address - Street 1:4102 N ROXBORO ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-2122
Practice Address - Country:US
Practice Address - Phone:919-595-2000
Practice Address - Fax:919-595-2190
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9401000207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC72175OtherBCBSNC
NC8972175Medicaid
NC19535OtherOPTICARE
NC5612887674OtherCIGNA
NC0852210OtherUNITED HEALTHCARE
NC23492OtherPARTNERS
NC429966OtherMAMSI
NC52203OtherMEDCOST
NC4540511OtherAETNA PPO
NC2442919OtherAETNA HMO
NCF69937Medicare UPIN
NC52203OtherMEDCOST