MEDICARE: ROBERT SOUTHERLAND 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	306326	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	:	1730613514
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT SOUTHERLAND MD

Provider Business Mailing Address
First Line	:	9 CAREY RD
Second Line	:
City	:	QUEENSBURY
State	:	NY
Zip	:	12804-7880
Country	:	US
Telephone Number	:	518-761-0300
Fax Number	:

Provider Business Practice Location Address
First Line	:	1830 COUNTY ROUTE 64
Second Line	:
City	:	SALEM
State	:	NY
Zip	:	12865-3404
Country	:	US
Telephone Number	:	518-824-2571
Fax Number	:	833-438-0104

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

Provider Enumeration Date	:	04/18/2017
Last Update Date	:	03/13/2026

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Directions to “ ROBERT SOUTHERLAND MD” Practice Location

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