Healthcare Provider Details

I. General information

NPI: 1841296225
Provider Name (Legal Business Name): MONICA SUSAN HALL-ROBERTSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 03/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1760 NICHOLASVILLE RD SUITE 202
LEXINGTON KY
40503-1471
US

IV. Provider business mailing address

1760 NICHOLASVILLE RD SUITE 202
LEXINGTON KY
40503-1471
US

V. Phone/Fax

Practice location:
  • Phone: 859-277-5711
  • Fax:
Mailing address:
  • Phone: 859-277-5711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number35815
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number35815
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35815
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: