Provider Demographics
NPI:1013181361
Name:DUCK ROBERTSHAW, MARY MARGARET (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:MARGARET
Last Name:DUCK ROBERTSHAW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 636256 CENTRAL CREDENTIALING
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-6256
Mailing Address - Country:US
Mailing Address - Phone:513-585-5501
Mailing Address - Fax:513-585-5511
Practice Address - Street 1:4460 RED BANK RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45227-2172
Practice Address - Country:US
Practice Address - Phone:513-475-7370
Practice Address - Fax:513-562-9098
Is Sole Proprietor?:No
Enumeration Date:2008-04-17
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-098241208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100207640Medicaid
IN201122970Medicaid
OH0066760Medicaid
IN201122970Medicaid