Provider Demographics
NPI:1699727008
Name:LEBLOND, ROBERT EDWARD (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:EDWARD
Last Name:LEBLOND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E MCBEE AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2842
Mailing Address - Country:US
Mailing Address - Phone:803-434-8603
Mailing Address - Fax:
Practice Address - Street 1:111 DOCTORS DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-5608
Practice Address - Country:US
Practice Address - Phone:864-797-7100
Practice Address - Fax:865-797-7105
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22091208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP00801325OtherRR MEDICARE
SCT62223Medicaid
SCG623365235Medicare PIN
SCT62223Medicaid
SCG623363640Medicare PIN
SCG623367951Medicare PIN