Provider Demographics
NPI:1710985148
Name:GREENWELL, ROBERT C JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:C
Last Name:GREENWELL
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:1589 SULPHUR SPRING RD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21227-2542
Mailing Address - Country:US
Mailing Address - Phone:410-536-5400
Mailing Address - Fax:410-737-2168
Practice Address - Street 1:301 SAINT PAUL PL
Practice Address - Street 2:SUITE 605
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-2102
Practice Address - Country:US
Practice Address - Phone:410-332-1111
Practice Address - Fax:410-332-1752
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2016-01-20
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Provider Licenses
StateLicense IDTaxonomies
MDD34334207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD441381400Medicaid
MD441381400Medicaid
MD441381400Medicaid