Provider Demographics
NPI:1205937992
Name:ROBERTSON, NOELLE CELINE (MD)
Entity type:Individual
Prefix:
First Name:NOELLE
Middle Name:CELINE
Last Name:ROBERTSON
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 1:2000 PERIMETER PARK DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-8442
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7535 CARPENTER FIRE STATION RD STE 101
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27519-8969
Practice Address - Country:US
Practice Address - Phone:984-215-4400
Practice Address - Fax:984-215-5660
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2004-00405207QS0010X
NC200400405207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5904811Medicaid
I40170Medicare UPIN
NC5904811Medicaid
NC2044057AMedicare PIN