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NPI Code Detail

MEDICARE: DR. CARMEN CRIBB ROBERTS D.O.

MEDICARE: DR. CARMEN CRIBB ROBERTS D.O.
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
1207Q00000XFamily Medicine PhysicianLL39358SC
2207Q00000XFamily Medicine Physician39358SC

Other Identifiers

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

General Provider Information

NPI Number : 1659722411
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CARMEN CRIBB ROBERTS D.O.
Provider Business Mailing Address
First Line : 200 E HOSPITAL ST
Second Line :
City : MANNING
State : SC
Zip : 29102-3160
Country : US
Telephone Number : 803-433-0439
Fax Number : 803-433-9840
Provider Business Practice Location Address
First Line : 200 E HOSPITAL ST
Second Line :
City : MANNING
State : SC
Zip : 29102-3160
Country : US
Telephone Number : 803-433-0439
Fax Number : 803-433-9840
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/23/2016
Last Update Date : 02/22/2021

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