MEDICARE: PORSCHE L. ROBERSON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	0101246759	VA
2	208000000X	Pediatrics Physician	42695	AL

General Provider Information

NPI Number	:	1003013459
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PORSCHE L. ROBERSON MD

Provider Business Mailing Address
First Line	:	PO BOX 2705
Second Line	:
City	:	HUNTSVILLE
State	:	AL
Zip	:	35804-2705
Country	:	US
Telephone Number	:	256-428-4950
Fax Number	:	256-828-0526

Provider Business Practice Location Address
First Line	:	13596 HIGHWAY 231 431 N STE 2
Second Line	:
City	:	HAZEL GREEN
State	:	AL
Zip	:	35750-8618
Country	:	US
Telephone Number	:	256-428-4950
Fax Number	:	256-828-0526

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2007
Last Update Date	:	06/22/2021

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