Provider Demographics
NPI:1114907474
Name:ROBERTSON, JASON W (MD)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:W
Last Name:ROBERTSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 CAMPUS BLVD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601
Mailing Address - Country:US
Mailing Address - Phone:540-667-1727
Mailing Address - Fax:540-722-3373
Practice Address - Street 1:190 CAMPUS BLVD
Practice Address - Street 2:SUITE 400
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-2872
Practice Address - Country:US
Practice Address - Phone:540-667-1727
Practice Address - Fax:540-722-3373
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101237738208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA348322OtherANTHEM