Provider Demographics
NPI:1548464084
Name:ROBERTS, SOLDREA L (MD, MBA, FACOG)
Entity type:Individual
Prefix:
First Name:SOLDREA
Middle Name:L
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:MD, MBA, FACOG
Other - Prefix:
Other - First Name:SOLDREA
Other - Middle Name:L
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5 BURCKMYER DR
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29907-1709
Mailing Address - Country:US
Mailing Address - Phone:843-476-2834
Mailing Address - Fax:
Practice Address - Street 1:7 ARLEY WAY STE 101
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-4301
Practice Address - Country:US
Practice Address - Phone:843-522-7820
Practice Address - Fax:843-522-7821
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-11
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036118542207Q00000X
IL0361185642207V00000X
OH35.120101207V00000X
OH57007666207V00000X
SC51675207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC516757Medicaid
IL1548464084OtherNPI
IL371324674OtherTX ID
SC51675OtherSC MEDICAL BOARD
IL336079697Medicaid