Basic Information
| Provider Information | |||||||||
| NPI: | 1487845285 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROBERTSON | ||||||||
| FirstName: | MARTA | ||||||||
| MiddleName: | HF | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 214 CLINIC DR | ||||||||
| Address2: | |||||||||
| City: | DONALDSONVILLE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 703464309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2254738151 | ||||||||
| FaxNumber: | 2256445213 | ||||||||
| Practice Location | |||||||||
| Address1: | 214 CLINIC DR | ||||||||
| Address2: | |||||||||
| City: | DONALDSONVILLE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 703464309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2254738151 | ||||||||
| FaxNumber: | 2256445213 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/06/2007 | ||||||||
| LastUpdateDate: | 01/10/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 203765 | LA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1006912 | 05 | LA | MEDICAID |