MEDICARE: KAISER J. ROBERTSON III M.D.

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	208800000X	Urology Physician	D0056832	MD

General Provider Information

NPI Number	:	1437106820
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAISER J. ROBERTSON III M.D.

Provider Business Mailing Address
First Line	:	25 CROSSROADS DR
Second Line	:	STE 306
City	:	OWINGS MILLS
State	:	MD
Zip	:	21117-5421
Country	:	US
Telephone Number	:	410-760-9400
Fax Number	:	410-787-1911

Provider Business Practice Location Address
First Line	:	806 LANDMARK DR
Second Line	:	SUITE 118
City	:	GLEN BURNIE
State	:	MD
Zip	:	21061-4980
Country	:	US
Telephone Number	:	410-760-9400
Fax Number	:	410-787-1911

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

Provider Enumeration Date	:	05/30/2006
Last Update Date	:	05/24/2012

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