Provider Demographics
NPI:1649261082
Name:ROBERTSON, JAMES WESLEY (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:WESLEY
Last Name:ROBERTSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 11646
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24506-1646
Mailing Address - Country:US
Mailing Address - Phone:434-200-5895
Mailing Address - Fax:434-200-7529
Practice Address - Street 1:1901 TATE SPRINGS RD
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-1109
Practice Address - Country:US
Practice Address - Phone:434-200-5895
Practice Address - Fax:434-200-7529
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101059030207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA541901162002OtherPCHP
VA300814OtherSOUTHERN HEALTH
VA010302641Medicaid
VA0134585OtherUNITED HEALTHCARE
VA143867OtherANTHEM/BC/BS
VAP00346497OtherMEDICARE RAILROAD CARRIER
VA010078849Medicaid
VA9341434OtherCIGNA
VAP00185408OtherRAILROAD MEDICARE
VA300814OtherSOUTHERN HEALTH
P00422286Medicare PIN
012927C39Medicare PIN
VAP00346497OtherMEDICARE RAILROAD CARRIER
VAP00185408OtherRAILROAD MEDICARE