Provider Demographics
NPI:1588695266
Name:NORTHROP, ROBERT C (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:C
Last Name:NORTHROP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:1410 TUSCULUM BLVD
Mailing Address - Street 2:STE 1700
Mailing Address - City:GREENEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37745-4286
Mailing Address - Country:US
Mailing Address - Phone:423-787-7100
Mailing Address - Fax:423-787-7109
Practice Address - Street 1:310 N STATE OF FRANKLIN RD STE 103
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-6063
Practice Address - Country:US
Practice Address - Phone:423-328-0163
Practice Address - Fax:423-787-7109
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD36287208600000X, 208600000X, 2086S0127X, 2086S0129X, 208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007313080OtherVIRGINIA MEDICAID
TN020052848OtherRAILROAD MEDICARE
TN3875209Medicaid
TNQ000959Medicaid
VI245736OtherANTHEM BCBS VIRGINIA
TN4043623OtherBCBS TENNESSEE
7443396OtherAETNA
VI245736OtherANTHEM BCBS VIRGINIA
TN3875209Medicaid
TN4043623OtherBCBS TENNESSEE