Healthcare Provider Details

I. General information

NPI: 1144264946
Provider Name (Legal Business Name): KENNETH BARRY ROBERTS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N ELM ST
GREENSBORO NC
27401-1004
US

IV. Provider business mailing address

PO BOX 13605
GREENSBORO NC
27415-3605
US

V. Phone/Fax

Practice location:
  • Phone: 336-832-8060
  • Fax:
Mailing address:
  • Phone: 336-547-1877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number9701565
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: