Provider Demographics
NPI:1225028129
Name:TOWNSEND, ROBERT GLENN III (DO)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:GLENN
Last Name:TOWNSEND
Suffix:III
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 896208
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28289-6208
Mailing Address - Country:US
Mailing Address - Phone:910-904-2350
Mailing Address - Fax:910-904-1037
Practice Address - Street 1:313 TEAL DR
Practice Address - Street 2:
Practice Address - City:RAEFORD
Practice Address - State:NC
Practice Address - Zip Code:28376-2527
Practice Address - Country:US
Practice Address - Phone:910-904-2350
Practice Address - Fax:910-904-1037
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2002-01536207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC135H5OtherBCBS
FH1001710OtherFIRST CAROLINA CARE
7358425OtherAETNA
NC89135H5Medicaid
C7050OtherMEDCOST
SCN01536Medicaid
NCP00021414 RAILROADMedicare PIN
C7050OtherMEDCOST
7358425OtherAETNA