Healthcare Provider Details

I. General information

NPI: 1740202902
Provider Name (Legal Business Name): MICHAEL S. ROBERTSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 12/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 NATIONWIDE DR
LYNCHBURG VA
24502-4271
US

IV. Provider business mailing address

114 NATIONWIDE DR
LYNCHBURG VA
24502-4271
US

V. Phone/Fax

Practice location:
  • Phone: 434-239-7890
  • Fax: 434-237-9222
Mailing address:
  • Phone: 434-239-7890
  • Fax: 434-237-9222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number0101239170
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: