Provider Demographics
NPI:1427145531
Name:MACDONALD, ROBERT L (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:L
Last Name:MACDONALD
Suffix:
Gender:M
Credentials:MD, PHD
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1161 21ST AVE S
Mailing Address - Street 2:A-0118 MCN
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37232-2551
Mailing Address - Country:US
Mailing Address - Phone:615-936-2287
Mailing Address - Fax:615-936-2996
Practice Address - Street 1:1161 21ST AVE S
Practice Address - Street 2:A-0118 MCN
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37232-2551
Practice Address - Country:US
Practice Address - Phone:615-936-2287
Practice Address - Fax:615-936-2996
Is Sole Proprietor?:No
Enumeration Date:2006-10-09
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD35559207T00000X
TN355592084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
E26643Medicare UPIN