Healthcare Provider Details

I. General information

NPI: 1770588816
Provider Name (Legal Business Name): ROGER JOHN ROBERTSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 06/21/2023
Certification Date: 06/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3480 EAGLE DR
CHAMBERSBURG PA
17202-7419
US

IV. Provider business mailing address

3480 EAGLE DR
CHAMBERSBURG PA
17202-7419
US

V. Phone/Fax

Practice location:
  • Phone: 717-404-3048
  • Fax:
Mailing address:
  • Phone: 717-404-3048
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD043727E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: