Provider Demographics
NPI:1477525111
Name:BYNUM, ROBERT WILLIAM IV (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:WILLIAM
Last Name:BYNUM
Suffix:IV
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 1:2605 FOREST HILLS RD SW STE A
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893-4448
Mailing Address - Country:US
Mailing Address - Phone:252-293-9898
Mailing Address - Fax:252-293-9915
Practice Address - Street 1:2605 FOREST HILLS RD SW STE A
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-4448
Practice Address - Country:US
Practice Address - Phone:252-293-9898
Practice Address - Fax:252-293-9915
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC24731207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8920580Medicaid
NC20580OtherBLUE CROSS BLUE SHEILD
NC20580OtherBLUE CROSS BLUE SHEILD
NC8920580Medicaid