MEDICARE: DR. VIRGINIA ELIZABETH 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	207Q00000X	Family Medicine Physician	187576	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548348782
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VIRGINIA ELIZABETH ROBERTSON MD

Provider Business Mailing Address
First Line	:	175 WILLOUGHBY ST APT 16H
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11201-5411
Country	:	US
Telephone Number	:	718-451-6032
Fax Number	:

Provider Business Practice Location Address
First Line	:	726 BROADWAY
Second Line	:	NYU SHC ROOM 405
City	:	NEW YORK
State	:	NY
Zip	:	10003
Country	:	US
Telephone Number	:	122-443-1000
Fax Number	:	212-443-1002

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

Provider Enumeration Date	:	11/02/2006
Last Update Date	:	05/28/2021

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