Provider Demographics
NPI:1134148745
Name:ROBERTS, EUGENE LEONARD JR (MD)
Entity type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:LEONARD
Last Name:ROBERTS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:EUGENE
Other - Middle Name:LEONARD
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:24 2ND AVE NE STE 201
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-5045
Mailing Address - Country:US
Mailing Address - Phone:828-324-9900
Mailing Address - Fax:828-324-8322
Practice Address - Street 1:24 2ND AVE NE STE 201
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-5045
Practice Address - Country:US
Practice Address - Phone:828-324-9900
Practice Address - Fax:828-324-8322
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1721202084P0800X
NC270812084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8972384Medicaid
NC72384OtherBCBS
NCD26858Medicare UPIN
NC2194299Medicare ID - Type Unspecified