Provider Demographics
NPI:1457369100
Name:PHILIP B ROBERTSON M.D.
Entity Type:Organization
Organization Name:PHILIP B ROBERTSON M.D.
Other - Org Name:PSYCHIATRIC ASSOCIATES OF THE VIRGINIAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:BRUNNER
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:276-326-2686
Mailing Address - Street 1:347 SANDPIPER AVE
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24740-4185
Mailing Address - Country:US
Mailing Address - Phone:304-425-2620
Mailing Address - Fax:276-326-2249
Practice Address - Street 1:105 WESTWOOD COMMONS
Practice Address - Street 2:
Practice Address - City:BLUEFIELD
Practice Address - State:VA
Practice Address - Zip Code:24605-2009
Practice Address - Country:US
Practice Address - Phone:276-326-2686
Practice Address - Fax:276-326-2249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0114647000Medicaid
VA7107340Medicaid
VAC35226Medicare UPIN
VACO9898Medicare Oscar/Certification