MEDICARE: SAMUEL T. ROBERTSON M. D. INC.

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	2084P0804X	Child & Adolescent Psychiatry Physician	35047921	OH

General Provider Information

NPI Number	:	1881122729
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAMUEL T. ROBERTSON M. D. INC.

Provider Business Mailing Address
First Line	:	333 LAFAYETTE AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45220-1122
Country	:	US
Telephone Number	:	513-519-5864
Fax Number	:

Provider Business Practice Location Address
First Line	:	333 LAFAYETTE AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45220-1122
Country	:	US
Telephone Number	:	513-519-5864
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. SAMUEL THOMAS ROBERTSON
Credential	:	M. D.
Telephone Number	:	513-519-5864

Provider Enumeration Date	:	05/23/2017
Last Update Date	:	07/21/2022

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