Provider Demographics
NPI:1326130824
Name:GUNTHER, ROBERT CARL (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:CARL
Last Name:GUNTHER
Suffix:
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 1:5107 N CROATAN HWY
Mailing Address - Street 2:
Mailing Address - City:KITTY HAWK
Mailing Address - State:NC
Mailing Address - Zip Code:27949-3989
Mailing Address - Country:US
Mailing Address - Phone:252-255-5321
Mailing Address - Fax:
Practice Address - Street 1:5107 N CROATAN HWY
Practice Address - Street 2:
Practice Address - City:KITTY HAWK
Practice Address - State:NC
Practice Address - Zip Code:27949-3989
Practice Address - Country:US
Practice Address - Phone:252-255-5321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2018-00749208000000X
VA0101036483208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006713980Medicaid
VA009329U92Medicare ID - Type Unspecified
VA006713980Medicaid