Provider Demographics
NPI:1629149331
Name:MARILYN MARIE ROBERTSON, M.D. INC
Entity Type:Organization
Organization Name:MARILYN MARIE ROBERTSON, M.D. INC
Other - Org Name:MARILYN M. ROBERTSON, M.D.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NEUROLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:M
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-268-3208
Mailing Address - Street 1:2299 POST ST STE 201
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-3473
Mailing Address - Country:US
Mailing Address - Phone:415-268-3208
Mailing Address - Fax:415-621-2947
Practice Address - Street 1:2299 POST ST STE 201
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-3473
Practice Address - Country:US
Practice Address - Phone:415-268-3208
Practice Address - Fax:415-621-2947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG69580174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF57113Medicare UPIN