Provider Demographics
NPI:1255339123
Name:ROBERTSON, SANDY J (MD)
Entity type:Individual
Prefix:
First Name:SANDY
Middle Name:J
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 1:527 POCKET RD
Mailing Address - Street 2:
Mailing Address - City:HURT
Mailing Address - State:VA
Mailing Address - Zip Code:24563-2023
Mailing Address - Country:US
Mailing Address - Phone:434-324-9150
Mailing Address - Fax:434-324-8248
Practice Address - Street 1:527 POCKET RD
Practice Address - Street 2:
Practice Address - City:HURT
Practice Address - State:VA
Practice Address - Zip Code:24563-2023
Practice Address - Country:US
Practice Address - Phone:434-324-9150
Practice Address - Fax:434-324-8248
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2015-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101235778207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CJ2302OtherMEDICARE RAILROAD
VAI01757Medicare UPIN
VA013497F32Medicare ID - Type Unspecified
VAVVF872AMedicare PIN