MEDICARE: LAURA JEANNE ROBERTSON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	D0039617	MD
2	2085R0202X	Diagnostic Radiology Physician	MD418614	PA

General Provider Information

NPI Number	:	1043294812
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA JEANNE ROBERTSON M.D.

Provider Business Mailing Address
First Line	:	2309 SHADED BROOK DR
Second Line	:
City	:	OWINGS MILLS
State	:	MD
Zip	:	21117-2349
Country	:	US
Telephone Number	:	410-902-1676
Fax Number	:

Provider Business Practice Location Address
First Line	:	3301 NEW MEXICO AVE NW
Second Line	:	SUITE 106
City	:	WASHINGTON
State	:	DC
Zip	:	20016-3622
Country	:	US
Telephone Number	:	202-966-0606
Fax Number	:	202-244-6757

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/05/2005
Last Update Date	:	09/11/2025

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