Provider Demographics
NPI:1881658904
Name:ROBERTS, ANGELA Y (MD)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:Y
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 NORTHLINE AVE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-7616
Mailing Address - Country:US
Mailing Address - Phone:336-286-6565
Mailing Address - Fax:336-286-6566
Practice Address - Street 1:3200 NORTHLINE AVE
Practice Address - Street 2:SUITE 130
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-7616
Practice Address - Country:US
Practice Address - Phone:336-286-6565
Practice Address - Fax:336-286-6566
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200301047174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891340GMedicaid
NC2021911Medicare ID - Type Unspecified
NC891340GMedicaid