Provider Demographics
NPI:1023048766
Name:ROBERTSON, JANE MELINDA (MD)
Entity type:Individual
Prefix:DR
First Name:JANE
Middle Name:MELINDA
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 1:1009 HILLPOINT BLVD.
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434
Mailing Address - Country:US
Mailing Address - Phone:757-668-2250
Mailing Address - Fax:757-668-2255
Practice Address - Street 1:1009 HILLPOINT BLVD.
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434
Practice Address - Country:US
Practice Address - Phone:757-668-2250
Practice Address - Fax:757-668-2255
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA101234705208000000X
VA101053995208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA541778786OtherUNITED HEALTH CARE
VA6706355Medicaid
VA35241OtherOPTIMA
VA5416130OtherAETNA
VA228114OtherANTHEM
VA541778786OtherVIRGINIA HEALTH NETWORK
VA541778786023OtherTRICARE
VA878411OtherMAMSI/MDIPA
VA006706355Medicaid
NC890639NMedicaid
VA541778786OtherUNITED HEALTH CARE