Provider Demographics
NPI:1770588816
Name:ROBERTSON, ROGER JOHN (MD)
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:JOHN
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 1:3480 EAGLE DR
Mailing Address - Street 2:
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17202-7419
Mailing Address - Country:US
Mailing Address - Phone:717-404-3048
Mailing Address - Fax:
Practice Address - Street 1:3480 EAGLE DR
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17202-7419
Practice Address - Country:US
Practice Address - Phone:717-404-3048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD043727E207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA120420411OtherDEPT OF LABOR
PA0011657940001Medicaid
PA123378OtherMEDPLUS
PA25-1716306OtherHEALTHNET/TRICARE
PA842364OtherAETNA HMO
PAP00183613OtherRAILROAD MEDICARE
PA1007307260034OtherMEDICAID GROUP #
PA2117055OtherALLIANCE PPO
PA01133901OtherCAPITAL BLUE CROSS
PA178152OtherHIGHMARK BLUE SHIELD
PA867633OtherMEDICARE GROUP #
PA25-1716306OtherDEVON
PA1593334OtherFIRST HEALTH
PA4349580OtherAENTA NON-HMO
PAMD043727EOtherLICENSE
PA867633OtherMEDICARE GROUP #
PAP00183613OtherRAILROAD MEDICARE
PA178152TGAMedicare PIN
PAE15019Medicare UPIN