Provider Demographics
NPI:1619137528
Name:ROBERTSON, CELTIN (MD)
Entity Type:Individual
Prefix:
First Name:CELTIN
Middle Name:
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 1:2820 FAIRLANE DR
Mailing Address - Street 2:STE A8
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36116-1631
Mailing Address - Country:US
Mailing Address - Phone:334-396-2056
Mailing Address - Fax:
Practice Address - Street 1:2820 FAIRLANE DR
Practice Address - Street 2:STE A8
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36116-1631
Practice Address - Country:US
Practice Address - Phone:334-396-2056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-13
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.31250207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine