Provider Demographics
NPI:1619995222
Name:GITTIN, ROBERT GLEN (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:GLEN
Last Name:GITTIN
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:PO BOX 209
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27216-0209
Mailing Address - Country:US
Mailing Address - Phone:336-538-7725
Mailing Address - Fax:336-538-7785
Practice Address - Street 1:1236 HUFFMAN MILL RD
Practice Address - Street 2:SUITE #120
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-8700
Practice Address - Country:US
Practice Address - Phone:336-538-7725
Practice Address - Fax:336-538-7785
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC31289207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8935666Medicaid
NC35666OtherBLUE CROSS BLUE SHIELD
NC4868OtherPARTNERS
NC35666OtherBLUE CROSS BLUE SHIELD
NCC84072Medicare UPIN