Provider Demographics
NPI:1497775811
Name:ROBERTSON, MARY S (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:S
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:PO BOX 236
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47006-0236
Mailing Address - Country:US
Mailing Address - Phone:812-933-5441
Mailing Address - Fax:812-933-5446
Practice Address - Street 1:1088 N STATE RD 229
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:IN
Practice Address - Zip Code:47006
Practice Address - Country:US
Practice Address - Phone:812-933-1858
Practice Address - Fax:812-933-1968
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01052054207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
110208877OtherTRAVELERS
IN200245400BMedicaid
000000079571OtherANTHEM
110208877OtherTRAVELERS
000000079571OtherANTHEM