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General NPI Number Information
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NPI Number | 1265638902
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Entity Type | Organization
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Legal Business Name | JOHN W ROBERTSON III MD, PC
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Dates
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Enumeration Date | 06/21/2007
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Last Update Date | 11/09/2007
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Provider Practice Location Address
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Address Line | 8080 OLD YORK RD SUITE 212
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City | ELKINS PARK
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State | PA
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Zip | 19027-1421
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Country | US
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Telephone | 267-763-1024
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Fax | 267-763-1050
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Provider Business Mailing Address
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Address Line | 8080 OLD YORK RD SUITE 212
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City | ELKINS PARK
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State | PA
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Zip | 19027-1421
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Country | US
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Telephone | 267-763-1024
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Fax | 267-763-1050
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Authorized Official
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Title or Position | OWNER
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Name | JOHN ROBERTSON
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Credential |
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Telephone | 267-763-1024
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | MD044947E
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License Number State | PA
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