Provider Demographics
NPI:1962473330
Name:ROBERTSON, EUGENIA CARYN (MD)
Entity Type:Individual
Prefix:DR
First Name:EUGENIA
Middle Name:CARYN
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:465 WHITE CEDAR LN
Mailing Address - Street 2:
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21146-3337
Mailing Address - Country:US
Mailing Address - Phone:443-794-0159
Mailing Address - Fax:
Practice Address - Street 1:479 JUMPERS HOLE RD STE 304A
Practice Address - Street 2:
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146-1753
Practice Address - Country:US
Practice Address - Phone:410-544-0053
Practice Address - Fax:410-544-7830
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-01
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0063270207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDCE9203Medicare PIN
MDP00275921Medicare PIN
MDK245 M520Medicare PIN
MDI43228Medicare UPIN