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Individual

ROBERTA J HAWK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
649 N NEW HOPE RD, GASTONIA, NC 28054-7424
(704) 866-4005
(704) 866-0450
Mailing address
1072 XRAY DR, GASTONIA, NC 28054
(704) 671-1094
(704) 671-1095

Taxonomy

Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
201802113
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000011761
BLUE CROSS
01
2018-02113
NC MEDICAL LICENSE
NC
01
260015882003
EBMS
01
NN4199A
NC MEDICARE
NC
Enumeration date
08/17/2006
Last updated
06/23/2020
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