Provider Demographics
NPI:1699938738
Name:ROBERTSON, TANIA R (MD)
Entity type:Individual
Prefix:DR
First Name:TANIA
Middle Name:R
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:#1 HOSPITAL ROAD
Mailing Address - Street 2:
Mailing Address - City:BELCOURT
Mailing Address - State:ND
Mailing Address - Zip Code:58316-0160
Mailing Address - Country:US
Mailing Address - Phone:701-477-6111
Mailing Address - Fax:701-477-2507
Practice Address - Street 1:#1 HOSPITAL ROAD
Practice Address - Street 2:
Practice Address - City:BELCOURT
Practice Address - State:ND
Practice Address - Zip Code:58316-0160
Practice Address - Country:US
Practice Address - Phone:701-477-6111
Practice Address - Fax:701-477-2507
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD72751207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine