Provider Demographics
NPI:1386721728
Name:ROBERTSON, MARILYN A (MD)
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:A
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 6730
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85246-6730
Mailing Address - Country:US
Mailing Address - Phone:480-821-3600
Mailing Address - Fax:804-821-3610
Practice Address - Street 1:2055 W FRYE RD STE 9
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-6277
Practice Address - Country:US
Practice Address - Phone:480-821-3600
Practice Address - Fax:480-821-3610
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY182625207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology