Provider Demographics
NPI:1548348782
Name:ROBERTSON, VIRGINIA ELIZABETH (MD)
Entity type:Individual
Prefix:DR
First Name:VIRGINIA
Middle Name:ELIZABETH
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:175 WILLOUGHBY ST APT 16H
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-5411
Mailing Address - Country:US
Mailing Address - Phone:718-451-6032
Mailing Address - Fax:
Practice Address - Street 1:726 BROADWAY
Practice Address - Street 2:NYU SHC ROOM 405
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003
Practice Address - Country:US
Practice Address - Phone:122-443-1000
Practice Address - Fax:212-443-1002
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2021-05-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY187576207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01516898Medicaid
NY01516898Medicaid