Provider Demographics
NPI:1316911787
Name:ROBERTSON, CYNTHIA RIA (MD)
Entity type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:RIA
Last Name:ROBERTSON
Suffix:
Gender:F
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:PO BOX 746
Mailing Address - Street 2:237 MAIN ST
Mailing Address - City:BINGHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04920
Mailing Address - Country:US
Mailing Address - Phone:207-672-4187
Mailing Address - Fax:207-672-3641
Practice Address - Street 1:237 MAIN ST
Practice Address - Street 2:
Practice Address - City:BINGHAM
Practice Address - State:ME
Practice Address - Zip Code:04920
Practice Address - Country:US
Practice Address - Phone:207-672-4187
Practice Address - Fax:207-672-3641
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME011644207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME291410099Medicaid
F14267Medicare UPIN
MEMM4051Medicare ID - Type Unspecified
ME291410099Medicaid