Provider Demographics
NPI:1932196664
Name:ROBERTSON, LAURA MARIE (MD)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:MARIE
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1324 BELMONT ST STE 105
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-4435
Mailing Address - Country:US
Mailing Address - Phone:508-427-6000
Mailing Address - Fax:508-583-7599
Practice Address - Street 1:1324 BELMONT ST STE 105
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-4435
Practice Address - Country:US
Practice Address - Phone:508-427-6000
Practice Address - Fax:508-427-6010
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA217107208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
6101419001OtherCIGNA
59977OtherFALLON
467518OtherTUFTS
AA1021OtherHPHC
MA2026988Medicaid
30195OtherBMC HEALTHNET
3388884OtherAETNA
J26849OtherBLUE CROSS
6101419001OtherCIGNA