1588695266 NPI number — DR. ROBERT C NORTHROP MD

Table of content: DR. ROBERT C NORTHROP MD (NPI 1588695266)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588695266 NPI number — DR. ROBERT C NORTHROP MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NORTHROP
Provider First Name:
ROBERT
Provider Middle Name:
C
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1588695266
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/04/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1410 TUSCULUM BLVD
Provider Second Line Business Mailing Address:
STE 1700
Provider Business Mailing Address City Name:
GREENEVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37745-4286
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-787-7100
Provider Business Mailing Address Fax Number:
423-787-7109

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
310 N STATE OF FRANKLIN RD STE 103
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JOHNSON CITY
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37604-6063
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-328-0163
Provider Business Practice Location Address Fax Number:
423-787-7109
Provider Enumeration Date:
07/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  MD36287 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 007313080 . This is a "VIRGINIA MEDICAID" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 020052848 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3875209 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: Q000959 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 245736 . This is a "ANTHEM BCBS VIRGINIA" identifier , issued by the state of ( VI ) . This identifiers is of the category "OTHER".
  • Identifier: 4043623 . This is a "BCBS TENNESSEE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 7443396 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".




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