Provider Demographics
NPI:1518955269
Name:ROBERTS, JOSEPH EARL JR (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:EARL
Last Name:ROBERTS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3005 N ELM ST
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-2984
Mailing Address - Country:US
Mailing Address - Phone:910-738-7789
Mailing Address - Fax:910-738-7599
Practice Address - Street 1:3005 N ELM ST
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-2984
Practice Address - Country:US
Practice Address - Phone:910-738-7789
Practice Address - Fax:910-738-7599
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2010-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC32959207Q00000X, 2084P0804X, 2084P0800X, 2084P0015X, 2084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0015XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychosomatic Medicine
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC71958OtherBLUE CROSS BLUE SHIELD
NC8971958Medicaid
NC2199836Medicare PIN
NC71958OtherBLUE CROSS BLUE SHIELD
E56716Medicare UPIN