Provider Demographics
NPI:1811983067
Name:ROBERTSON, DAVID J (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:J
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 1:135 N EWING ST
Mailing Address - Street 2:STE 304
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130
Mailing Address - Country:US
Mailing Address - Phone:740-687-5437
Mailing Address - Fax:740-687-6330
Practice Address - Street 1:618 PLEASANTVILLE RD STE 301
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-3373
Practice Address - Country:US
Practice Address - Phone:740-687-5437
Practice Address - Fax:740-687-6330
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35082043R208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000331183OtherANTHEM
OHP00154234OtherRR MEDICARE
0007040586OtherAETNA
1703033OtherUHC
OH2479009Medicaid
OHR04131901Medicare ID - Type Unspecified
OH2479009Medicaid