Provider Demographics
NPI:1770582686
Name:ROBERTSON, STEVEN P (MD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:P
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 1:885 DAMON DR
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-2009
Mailing Address - Country:US
Mailing Address - Phone:330-410-6230
Mailing Address - Fax:
Practice Address - Street 1:20 S 3RD ST STE 210
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-4206
Practice Address - Country:US
Practice Address - Phone:844-326-3119
Practice Address - Fax:855-737-5542
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301114379207R00000X
OH35-07-7830207R00000X, 208000000X
OH77830207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2187431Medicaid
OHRO4180944Medicare ID - Type Unspecified
OH2187431Medicaid