Individual
MARY S ROBERTSON
Active
Individual
MARY S ROBERTSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
01052054
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000079571
ANTHEM
—
01
—
110208877
TRAVELERS
—
05
—
200245400B
—
IN
Enumeration date
07/20/2006
Last updated
03/29/2021
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