Provider Demographics
NPI:1265647945
Name:ROBERTSON, DAVID M (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:M
Last Name:ROBERTSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:90 CAREW ST UNIT B
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01104-3405
Mailing Address - Country:US
Mailing Address - Phone:414-707-6460
Mailing Address - Fax:413-707-6440
Practice Address - Street 1:90 CAREW ST UNIT B
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104-3405
Practice Address - Country:US
Practice Address - Phone:414-707-6460
Practice Address - Fax:413-707-6440
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA240557207R00000X, 208000000X, 207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAS400181814Medicare PIN
MA001142603Medicare PIN