MEDICARE: MONICA SUSAN HALL-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	208200000X	Plastic Surgery Physician	35815	KY
2	208600000X	Surgery Physician	35815	KY
3	207Q00000X	Family Medicine Physician	35815	KY

General Provider Information

NPI Number	:	1841296225
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MONICA SUSAN HALL-ROBERTSON MD

Provider Business Mailing Address
First Line	:	1760 NICHOLASVILLE RD
Second Line	:	SUITE 202
City	:	LEXINGTON
State	:	KY
Zip	:	40503-1471
Country	:	US
Telephone Number	:	859-277-5711
Fax Number	:

Provider Business Practice Location Address
First Line	:	1760 NICHOLASVILLE RD
Second Line	:	SUITE 202
City	:	LEXINGTON
State	:	KY
Zip	:	40503-1471
Country	:	US
Telephone Number	:	859-277-5711
Fax Number	:

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

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	03/05/2019

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