Provider Demographics
NPI:1316940547
Name:BASHUK, ROBERT GLEN (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:GLEN
Last Name:BASHUK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2200 CENTURY PKWY NE STE 260
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30345-3103
Mailing Address - Country:US
Mailing Address - Phone:404-946-9327
Mailing Address - Fax:833-941-2436
Practice Address - Street 1:2200 CENTURY PKWY NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30345-3154
Practice Address - Country:US
Practice Address - Phone:404-946-9327
Practice Address - Fax:833-941-2436
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2025-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0264512084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA130014132OtherRAILROAD MEDICARE
GA000345639SMedicaid
GA13BDCQBMedicare ID - Type Unspecified
GAD39360Medicare UPIN
GA130014132Medicare PIN