Basic Information
| Provider Information | |||||||||
| NPI: | 1316058134 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROBERSON | ||||||||
| FirstName: | ARTHUR | ||||||||
| MiddleName: | E | ||||||||
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| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2800 GODWIN BLVD FL 1 | ||||||||
| Address2: | |||||||||
| City: | SUFFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 234348038 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7579344821 | ||||||||
| FaxNumber: | 7579344276 | ||||||||
| Practice Location | |||||||||
| Address1: | 2800 GODWIN BLVD FL 1 | ||||||||
| Address2: | |||||||||
| City: | SUFFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 234348038 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7579344821 | ||||||||
| FaxNumber: | 7579344276 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2006 | ||||||||
| LastUpdateDate: | 09/21/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/21/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | 0101228977 | VA | N | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | 0101228977 | VA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1316058134 | 05 | VA | MEDICAID | 885901 | 01 | VA | MAMSI | OTHER | 7074184 | 01 | VA | AETNA | OTHER | 101051 | 01 | VA | BLACK LUNG | OTHER | 010294193 | 05 | VA | MEDICAID |