Provider Demographics
NPI:1790784247
Name:ROBES, CECILE THERESA (DO)
Entity Type:Individual
Prefix:DR
First Name:CECILE
Middle Name:THERESA
Last Name:ROBES
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:19485 OLD JETTON RD STE 100
Practice Address - Street 2:
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-6583
Practice Address - Country:US
Practice Address - Phone:704-316-5170
Practice Address - Fax:704-316-5172
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2003-00694207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC135H6OtherBCBS
G14579Medicare UPIN
NC2401474BMedicare PIN
4668202OtherAETNA
C7511OtherMEDCOST
FH1001715OtherFIRST CAROLINA CARE
SCN0069JMedicaid
NCP00027889 RAILROADMedicare PIN
NC89135H6Medicaid