Individual
MARK D ROBERTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2845 E HIGHWAY 76, SUITE 4, MULLINS, SC 29574-6037
(843) 431-2720
(843) 431-2726
Mailing address
2845 E HIGHWAY 76, SUITE 4, MULLINS, SC 29574-6037
(843) 431-2720
(843) 431-2726
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
28818
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
288183
—
SC
05
—
GP0861
—
SC
01
—
GP5462
MEDICAID GROUP
SC
05
—
RHC538
—
SC
Enumeration date
07/27/2006
Last updated
10/15/2020
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