Provider Demographics
NPI:1548269962
Name:ROBLES, EDWARD CONRAD (MD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:CONRAD
Last Name:ROBLES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-316-5388
Mailing Address - Fax:704-316-1848
Practice Address - Street 1:10305 HAMPTONS PARK DR STE 101
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-7217
Practice Address - Country:US
Practice Address - Phone:704-316-5388
Practice Address - Fax:704-316-1848
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301066617208100000X, 2084N0400X
NC2015-002662084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1548269962Medicaid
MI104127966Medicaid
MI104127966Medicaid
NCNCO677AMedicare PIN
MIH06587Medicare UPIN