Provider Demographics
NPI:1952302580
Name:ROBERTSON, GILES M (MD)
Entity Type:Individual
Prefix:DR
First Name:GILES
Middle Name:M
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 1:107 WADSWORTH DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23236-4521
Mailing Address - Country:US
Mailing Address - Phone:804-330-4901
Mailing Address - Fax:804-330-9142
Practice Address - Street 1:223 WADSWORTH DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23236-4510
Practice Address - Country:US
Practice Address - Phone:804-560-9868
Practice Address - Fax:804-330-4134
Is Sole Proprietor?:No
Enumeration Date:2005-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA207RG0100X174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5644348Medicaid
VA5644348Medicaid