Basic Information
| Provider Information | |||||||||
| NPI: | 1619995222 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GITTIN | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | GLEN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 209 | ||||||||
| Address2: | |||||||||
| City: | BURLINGTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 272160209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3365387725 | ||||||||
| FaxNumber: | 3365387785 | ||||||||
| Practice Location | |||||||||
| Address1: | 1236 HUFFMAN MILL RD | ||||||||
| Address2: | SUITE #120 | ||||||||
| City: | BURLINGTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 272158700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3365387725 | ||||||||
| FaxNumber: | 3365387785 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2006 | ||||||||
| LastUpdateDate: | 10/10/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | 31289 | NC | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 8935666 | 05 | NC | MEDICAID | 35666 | 01 | NC | BLUE CROSS BLUE SHIELD | OTHER | 4868 | 01 | NC | PARTNERS | OTHER |