Healthcare Provider Details

I. General information

NPI: 1235887498
Provider Name (Legal Business Name): IAN JAMES ROBERTSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: IAN ROBERTSON MD

II. Dates (important events)

Enumeration Date: 03/16/2022
Last Update Date: 03/16/2022
Certification Date: 03/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4494 PALMER RD N WALTER REED NATIONAL MILITARY MEDICAL CENTER
BETHESDA MD
20814
US

IV. Provider business mailing address

5 NIANTIC ST
MEDFIELD MA
02052-2901
US

V. Phone/Fax

Practice location:
  • Phone: 301-295-4000
  • Fax:
Mailing address:
  • Phone: 508-479-1174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: