Basic Information
| Provider Information | |||||||||
| NPI: | 1295092484 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROUNDTREE | ||||||||
| FirstName: | VONTRELLE | ||||||||
| MiddleName: | LYNETTE | ||||||||
| NamePrefix: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 250 | ||||||||
| Address2: | |||||||||
| City: | BEAVER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 150090250 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8006340201 | ||||||||
| FaxNumber: | 8667270896 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 HEART DR | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278348982 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2528474267 | ||||||||
| FaxNumber: | 2528471245 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2012 | ||||||||
| LastUpdateDate: | 12/12/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/12/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 2013-01880 | NC | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.