MEDICARE: DR. EDWARD CONRAD ROBLES MD

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	208100000X	Physical Medicine & Rehabilitation Physician	4301066617	MI
2	2084N0400X	Neurology Physician	4301066617	MI
3	2084N0400X	Neurology Physician	2015-00266	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548269962
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWARD CONRAD ROBLES MD

Provider Business Mailing Address
First Line	:	PO BOX 60447
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-0447
Country	:	US
Telephone Number	:	704-316-5388
Fax Number	:	704-316-1848

Provider Business Practice Location Address
First Line	:	10305 HAMPTONS PARK DR STE 101
Second Line	:
City	:	HUNTERSVILLE
State	:	NC
Zip	:	28078-7217
Country	:	US
Telephone Number	:	704-316-5388
Fax Number	:	704-316-1848

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

Provider Enumeration Date	:	07/18/2005
Last Update Date	:	06/04/2024

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