Provider Demographics
NPI:1275635948
Name:ROBERTSON, WILLIETTE MARIA (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIETTE
Middle Name:MARIA
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 1:208 S WESTMOOR AVE APT A
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-3664
Mailing Address - Country:US
Mailing Address - Phone:614-570-7409
Mailing Address - Fax:
Practice Address - Street 1:1912 TAMARACK RD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-2303
Practice Address - Country:US
Practice Address - Phone:614-257-5910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35073035207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine