Provider Demographics
NPI:1063683688
Name:ROBERTSON, LORRAINE D (MD)
Entity Type:Individual
Prefix:DR
First Name:LORRAINE
Middle Name:D
Last Name:ROBERTSON
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 1:21 BROWN CT
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:NJ
Mailing Address - Zip Code:07930-2481
Mailing Address - Country:US
Mailing Address - Phone:908-879-1044
Mailing Address - Fax:908-879-1144
Practice Address - Street 1:21 BROWN CT
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:NJ
Practice Address - Zip Code:07930-2481
Practice Address - Country:US
Practice Address - Phone:908-879-1044
Practice Address - Fax:908-879-1144
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-23
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA29876207Q00000X, 207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine