Provider Demographics
NPI:1295092484
Name:ROUNDTREE, VONTRELLE LYNETTE (MD)
Entity type:Individual
Prefix:
First Name:VONTRELLE
Middle Name:LYNETTE
Last Name:ROUNDTREE
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:PO BOX 250
Mailing Address - Street 2:
Mailing Address - City:BEAVER
Mailing Address - State:PA
Mailing Address - Zip Code:15009-0250
Mailing Address - Country:US
Mailing Address - Phone:800-634-0201
Mailing Address - Fax:866-727-0896
Practice Address - Street 1:101 HEART DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-8982
Practice Address - Country:US
Practice Address - Phone:252-847-4267
Practice Address - Fax:252-847-1245
Is Sole Proprietor?:No
Enumeration Date:2012-04-12
Last Update Date:2020-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2013-01880207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNCP696A759Medicare PIN