Basic Information
| Provider Information | |||||||||
| NPI: | 1316944689 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GEWIRTZ | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 7527 | ||||||||
| Address2: | |||||||||
| City: | DUBLIN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430170727 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142689561 | ||||||||
| FaxNumber: | 6142687849 | ||||||||
| Practice Location | |||||||||
| Address1: | 1030 REFUGEE RD STE 280 | ||||||||
| Address2: | |||||||||
| City: | PICKERINGTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 431470019 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6145335500 | ||||||||
| FaxNumber: | 6145330103 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2005 | ||||||||
| LastUpdateDate: | 01/17/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/17/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | 35.078086 | OH | Y | Allopathic & Osteopathic Physicians | Neurological Surgery |
ID Information
| ID | Type | State | Issuer | Description | 64320971 | 05 | KY | MEDICAID | 9057268004 | 01 | OH | UNITED HEALTHCARE PIN | OTHER | 000000209165 | 01 | OH | ANTHEM PIN | OTHER | 310874776026 | 01 | OH | CARESOURCE PIN | OTHER | 5192036 | 01 | OH | AETNA PIN | OTHER | 9057268004 | 01 | OH | CIGNA HEALTHCARE PIN | OTHER | 2191104 | 05 | OH | MEDICAID |