Basic Information
Provider Information
NPI: 1003013459
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ROBERSON
FirstName: PORSCHE
MiddleName: L.
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 9007
Address2:  
City: CHARLOTTESVILLE
State: VA
PostalCode: 229069007
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 661 UNIVERSITY LN STE A
Address2:  
City: ORANGE
State: VA
PostalCode: 229602243
CountryCode: US
TelephoneNumber: 5406613025
FaxNumber: 5406613021
Other Information
ProviderEnumerationDate: 06/29/2007
LastUpdateDate: 08/21/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208000000X0101246759VAY Allopathic & Osteopathic PhysiciansPediatrics 
390200000X0116019773VAN Student, Health CareStudent in an Organized Health Care Education/Training Program 

No ID Information.


Home