Basic Information
| Provider Information | |||||||||
| NPI: | 1407823255 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROBERTSON | ||||||||
| FirstName: | SCOTT | ||||||||
| MiddleName: | ALAN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 301 RIVERVIEW AVE | ||||||||
| Address2: | SUITE 700 | ||||||||
| City: | NORFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 235101065 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7572529365 | ||||||||
| FaxNumber: | 7579627217 | ||||||||
| Practice Location | |||||||||
| Address1: | 301 RIVERVIEW AVE | ||||||||
| Address2: | SUITE 700 | ||||||||
| City: | NORFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 23510 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7572529365 | ||||||||
| FaxNumber: | 7579627217 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/01/2006 | ||||||||
| LastUpdateDate: | 05/17/2018 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 0101055677 | VA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RI0011X | 0101055677 | VA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology |
ID Information
| ID | Type | State | Issuer | Description | 298696 | 01 | VA | MAMSI | OTHER | PAR | 01 | VA | CORVEL/CORCARE | OTHER | 065CR | 01 | NC | BC/BS NC | OTHER | 398696 | 01 | VA | UHC/MAMSI/MDIPA | OTHER | 466989 | 01 | VA | ATHEM BC/BS VA/HK | OTHER | 53044 | 01 | VA | OPTIMA HEALTH PLAN | OTHER | 010008336 | 05 | VA | MEDICAID | 89065CR | 05 | NC | MEDICAID | PAR | 01 | VA | CIGNA | OTHER | PAR | 01 | VA | VIRGINIA HEALTH NETWORK | OTHER | PAR | 01 | VA | USA MANAGED CARE | OTHER | -001 | 01 | VA | CHAMPUS/TRICARE | OTHER | PAR | 01 | VA | MULTIPLAN | OTHER | 287519 | 01 | VA | ANTHEM BC/BS AND HKP | OTHER | 70998 | 01 | VA | SENTARA OHP/SHP | OTHER | PAR | 01 | VA | AETNA | OTHER | PAR | 01 | VA | FIRST HEALTH COMMERCIAL/SOUTHERN HEALTH/COVENTRY | OTHER | 005868092 | 05 | VA | MEDICAID | PAR | 01 | VA | VIRGINIA PREMIER HEALTH | OTHER |