Provider Demographics
NPI:1407823255
Name:ROBERTSON, SCOTT ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:ALAN
Last Name:ROBERTSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 RIVERVIEW AVE
Mailing Address - Street 2:SUITE 700
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23510-1065
Mailing Address - Country:US
Mailing Address - Phone:757-252-9365
Mailing Address - Fax:757-962-7217
Practice Address - Street 1:301 RIVERVIEW AVE
Practice Address - Street 2:SUITE 700
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510
Practice Address - Country:US
Practice Address - Phone:757-252-9365
Practice Address - Fax:757-962-7217
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101055677207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA298696OtherMAMSI
VAPAROtherCORVEL/CORCARE
NC065CROtherBC/BS NC
VA398696OtherUHC/MAMSI/MDIPA
VA466989OtherATHEM BC/BS VA/HK
VA53044OtherOPTIMA HEALTH PLAN
VA010008336Medicaid
NC89065CRMedicaid
VAPAROtherCIGNA
VAPAROtherVIRGINIA HEALTH NETWORK
VAPAROtherUSA MANAGED CARE
VA-001OtherCHAMPUS/TRICARE
VAPAROtherMULTIPLAN
VA287519OtherANTHEM BC/BS AND HKP
VA70998OtherSENTARA OHP/SHP
VAPAROtherAETNA
VAPAROtherFIRST HEALTH COMMERCIAL/SOUTHERN HEALTH/COVENTRY
VA005868092Medicaid
VAPAROtherVIRGINIA PREMIER HEALTH
VA398696OtherUHC/MAMSI/MDIPA
VAG46498Medicare UPIN
VAPAROtherCIGNA
NC89065CRMedicaid
VA005868092Medicaid