Provider Demographics
NPI:1740390947
Name:ROBERTSON, ANDREW W (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:W
Last Name:ROBERTSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2797
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68103-2797
Mailing Address - Country:US
Mailing Address - Phone:402-354-4230
Mailing Address - Fax:402-354-6171
Practice Address - Street 1:717 N 190TH PLZ
Practice Address - Street 2:SUITE 2400
Practice Address - City:ELKHORN
Practice Address - State:NE
Practice Address - Zip Code:68022-3913
Practice Address - Country:US
Practice Address - Phone:402-815-1970
Practice Address - Fax:402-815-1595
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE18386207VM0101X, 363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1965673Medicaid
NE470376604-16Medicaid
IA95150Medicaid
IA1740390947Medicaid
IA1740390947Medicaid
IA95150Medicaid