Provider Demographics
NPI:1053392126
Name:ROBERTSON, MICHAEL ALEXANDER SR (PA-C)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:ALEXANDER
Last Name:ROBERTSON
Suffix:SR
Gender:M
Credentials:PA-C
Other - Prefix:
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Mailing Address - Street 1:8263 GLADE BANK DR
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20111-5229
Mailing Address - Country:US
Mailing Address - Phone:703-530-7937
Mailing Address - Fax:
Practice Address - Street 1:DELORENZO HEALTH CLINIC
Practice Address - Street 2:PENTAGON
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22202
Practice Address - Country:US
Practice Address - Phone:703-607-1599
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-07
Last Update Date:2007-07-08
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical