Provider Demographics
NPI:1154382612
Name:ROBERTSON, THOMAS J JR (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:J
Last Name:ROBERTSON
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 JONES RD
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-8207
Mailing Address - Country:US
Mailing Address - Phone:252-443-1006
Mailing Address - Fax:252-937-8366
Practice Address - Street 1:450 JONES RD
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-8207
Practice Address - Country:US
Practice Address - Phone:252-443-1006
Practice Address - Fax:252-937-8366
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101044852207W00000X
NC9800130207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1104ROtherBCBS
NC891104RMedicaid
NC2247685Medicare ID - Type Unspecified
NC891104RMedicaid