Provider Demographics
NPI:1851145114
Name:ROBERTSON, MADELINE MAE
Entity Type:Individual
Prefix:
First Name:MADELINE
Middle Name:MAE
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8407 MORRELL LN
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-6348
Mailing Address - Country:US
Mailing Address - Phone:603-978-9880
Mailing Address - Fax:
Practice Address - Street 1:8407 MORRELL LN
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-6348
Practice Address - Country:US
Practice Address - Phone:603-978-9880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program