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General NPI Number Information
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NPI Number | 1275631319
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Entity Type | Individual
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Provider Name | VIDA B ROBERTSON MD
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Gender | Female
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 12 AND A HALF WALL ST SUITE M
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City | ASHEVILLE
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State | NC
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Zip | 28801
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Country | US
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Telephone | 828-243-2071
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Fax |
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Provider Business Mailing Address
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Address Line | 12 1/2 WALL STREET SUITE M
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City | ASHEVILLE
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State | NC
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Zip | 28801
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Country | US
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Telephone | 828-243-2071
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 2000601106
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License Number State | NC
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