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General NPI Number Information
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NPI Number | 1932196664
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Entity Type | Individual
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Provider Name | LAURA MARIE ROBERTSON MD
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Gender | Female
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Dates
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Enumeration Date | 09/27/2005
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Last Update Date | 12/22/2021
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Provider Practice Location Address
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Address Line | 1324 BELMONT ST STE 105
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City | BROCKTON
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State | MA
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Zip | 02301-4435
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Country | US
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Telephone | 508-427-6000
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Fax | 508-427-6010
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Provider Business Mailing Address
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Address Line | 1324 BELMONT ST STE 105
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City | BROCKTON
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State | MA
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Zip | 02301-4435
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Country | US
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Telephone | 508-427-6000
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Fax | 508-583-7599
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 217107
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License Number State | MA
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