MEDICARE: GYNECOLOGY & LAPAROSCOPIC SURGEONS, PC

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	207VG0400X	Gynecology Physician	200001221175	NC

General Provider Information

NPI Number	:	1578527446
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GYNECOLOGY & LAPAROSCOPIC SURGEONS, PC

Provider Business Mailing Address
First Line	:	10941 RAVEN RIDGE RD
Second Line	:	SUITE 109
City	:	RALEIGH
State	:	NC
Zip	:	27614-6487
Country	:	US
Telephone Number	:	919-847-7475
Fax Number	:

Provider Business Practice Location Address
First Line	:	10941 RAVEN RIDGE RD
Second Line	:	SUITE 109
City	:	RALEIGH
State	:	NC
Zip	:	27614-6487
Country	:	US
Telephone Number	:	919-847-7475
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT & OWNER
Name	:	DR. LISA M. ROBERTS
Credential	:	M.D.
Telephone Number	:	919-847-7475

Provider Enumeration Date	:	04/17/2006
Last Update Date	:	08/22/2020

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