Basic Information
| Provider Information | |||||||||
| NPI: | 1770588816 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROBERTSON | ||||||||
| FirstName: | ROGER | ||||||||
| MiddleName: | JOHN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 785 5TH AVENUE | ||||||||
| Address2: | SUITE 3 | ||||||||
| City: | CHAMBERSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 172014232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172639555 | ||||||||
| FaxNumber: | 7172174217 | ||||||||
| Practice Location | |||||||||
| Address1: | 120 N 7TH ST STE 101 | ||||||||
| Address2: | |||||||||
| City: | CHAMBERSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 172011795 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172631220 | ||||||||
| FaxNumber: | 7172636255 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2005 | ||||||||
| LastUpdateDate: | 09/10/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | MD043727E | PA | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 120420411 | 01 | PA | DEPT OF LABOR | OTHER | P00183613 | 01 | PA | RAILROAD MEDICARE | OTHER | 01133901 | 01 | PA | CAPITAL BLUE CROSS | OTHER | 25-1716306 | 01 | PA | HEALTHNET/TRICARE | OTHER | 842364 | 01 | PA | AETNA HMO | OTHER | 178152 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | 123378 | 01 | PA | MEDPLUS | OTHER | 1593334 | 01 | PA | FIRST HEALTH | OTHER | 2117055 | 01 | PA | ALLIANCE PPO | OTHER | BR0577772 | 01 | PA | DEA | OTHER | MD043727E | 01 | PA | LICENSE | OTHER | 0011657940001 | 05 | PA | MEDICAID | 4349580 | 01 | PA | AENTA NON-HMO | OTHER | 1007307260034 | 01 | PA | MEDICAID GROUP # | OTHER | 25-1716306 | 01 | PA | DEVON | OTHER | 867633 | 01 | PA | MEDICARE GROUP # | OTHER |