Provider Demographics
NPI:1205060597
Name:ROBERTSON, TED EMMONS (MD)
Entity type:Individual
Prefix:
First Name:TED
Middle Name:EMMONS
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 1:1055 SHARON-COPLEY ROAD
Mailing Address - Street 2:
Mailing Address - City:WADSWORTH
Mailing Address - State:OH
Mailing Address - Zip Code:44281-9774
Mailing Address - Country:US
Mailing Address - Phone:330-239-4021
Mailing Address - Fax:330-239-4021
Practice Address - Street 1:1055 SHARON-COPLEY ROAD
Practice Address - Street 2:
Practice Address - City:WADSWORTH
Practice Address - State:OH
Practice Address - Zip Code:44281-9774
Practice Address - Country:US
Practice Address - Phone:330-239-4021
Practice Address - Fax:330-239-4021
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-14
Last Update Date:2009-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-026683207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology