MEDICARE: TED EMMONS ROBERTSON 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	207V00000X	Obstetrics & Gynecology Physician	35-026683	OH

General Provider Information

NPI Number	:	1205060597
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TED EMMONS ROBERTSON MD

Provider Business Mailing Address
First Line	:	1055 SHARON-COPLEY ROAD
Second Line	:
City	:	WADSWORTH
State	:	OH
Zip	:	44281-9774
Country	:	US
Telephone Number	:	330-239-4021
Fax Number	:	330-239-4021

Provider Business Practice Location Address
First Line	:	1055 SHARON-COPLEY ROAD
Second Line	:
City	:	WADSWORTH
State	:	OH
Zip	:	44281-9774
Country	:	US
Telephone Number	:	330-239-4021
Fax Number	:	330-239-4021

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

Provider Enumeration Date	:	05/14/2009
Last Update Date	:	05/14/2009

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