Healthcare Provider Details

I. General information

NPI: 1992448047
Provider Name (Legal Business Name): FORREST ANDREW ROBERSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2022
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3706 S MAIN ST STE B
BLACKSBURG VA
24060-7006
US

IV. Provider business mailing address

3706 S MAIN ST STE B
BLACKSBURG VA
24060-7006
US

V. Phone/Fax

Practice location:
  • Phone: 540-951-3376
  • Fax: 540-951-1276
Mailing address:
  • Phone: 540-951-3376
  • Fax: 540-951-1276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number0101283261
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: