Provider Demographics
NPI:1902810500
Name:ROBERTSON, LESTER E (MD)
Entity type:Individual
Prefix:DR
First Name:LESTER
Middle Name:E
Last Name:ROBERTSON
Suffix:
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 1:836 E 65TH ST STE 4
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-4491
Mailing Address - Country:US
Mailing Address - Phone:912-354-6187
Mailing Address - Fax:912-355-9807
Practice Address - Street 1:225 CANDLER DR
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-6023
Practice Address - Country:US
Practice Address - Phone:912-354-6187
Practice Address - Fax:912-354-6765
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC13159207RH0003X
GA039666207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000646962DMedicaid
GA039666OtherMEDICAL LICENSE
SCG39666Medicaid
GA000646962BMedicaid
GA000646962AMedicaid
GA039666OtherMEDICAL LICENSE
GA000646962AMedicaid
SCG39666Medicaid
SCC689506949Medicare PIN
GA83BBBFHMedicare PIN
GA83BBBJSMedicare PIN