Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | 37083 | MA |
NPI | 1003885203 |
---|---|
Provider Name | Dr. Edgar W Robertson |
First Address | Peabody, MA 01960-2910 |
Second Address | Peabody, MA 01960-2910 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/03/2006 |
Last Update Date | 13/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2022893 | (05) | MA |
B98642 | (02) | MA |