MEDICARE: JENNIFER L ROBERTS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	2012-01631	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518124916
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER L ROBERTS M.D.

Provider Business Mailing Address
First Line	:	3009 WAUGHTOWN ST
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27107-1634
Country	:	US
Telephone Number	:	336-293-8728
Fax Number	:	336-448-5503

Provider Business Practice Location Address
First Line	:	3009 WAUGHTOWN ST
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27107-1634
Country	:	US
Telephone Number	:	336-293-8728
Fax Number	:	336-448-5503

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2008
Last Update Date	:	12/04/2017

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