Provider Demographics
NPI:1487845285
Name:ROBERTSON, MARTA HF (MD)
Entity Type:Individual
Prefix:
First Name:MARTA
Middle Name:HF
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 1:214 CLINIC DR
Mailing Address - Street 2:
Mailing Address - City:DONALDSONVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70346-4309
Mailing Address - Country:US
Mailing Address - Phone:225-473-8151
Mailing Address - Fax:225-644-5213
Practice Address - Street 1:214 CLINIC DR
Practice Address - Street 2:
Practice Address - City:DONALDSONVILLE
Practice Address - State:LA
Practice Address - Zip Code:70346-4309
Practice Address - Country:US
Practice Address - Phone:225-473-8151
Practice Address - Fax:225-644-5213
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA203765207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1006912Medicaid
LA4P254Medicare PIN