Basic Information
Provider Information
NPI: 1114907581
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BARRETT
FirstName: ROLLAND
MiddleName: J
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 75216
Address2:  
City: CHARLOTTE
State: NC
PostalCode: 282755216
CountryCode: US
TelephoneNumber: 3367187080
FaxNumber: 3367189622
Practice Location
Address1: 3333 SILAS CREEK PKWY
Address2:  
City: WINSTON SALEM
State: NC
PostalCode: 271033013
CountryCode: US
TelephoneNumber: 3362778800
FaxNumber: 3362778850
Other Information
ProviderEnumerationDate: 01/20/2006
LastUpdateDate: 10/25/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 09/29/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207VX0201X29214NCY Allopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology

ID Information
IDTypeStateIssuerDescription
740156401 UNITED HEALTHCAREOTHER
309935401 AETNA HMOOTHER
891354405NC MEDICAID
409788701 AETNA PPOOTHER
00600557805VA MEDICAID
5246701NCMEDCOSTOTHER
1354401NCBLUE CROSS AND BLUE SHIELOTHER
55001NCPARTNERS NATIONAL HEALTHOTHER
P0003130401 RAILROAD MEDICAREOTHER


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