Provider Demographics
NPI:1932185626
Name:BLITSTEIN, BRYAN DREW (MD)
Entity type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:DREW
Last Name:BLITSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 110566
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27709-5566
Mailing Address - Country:US
Mailing Address - Phone:919-620-4555
Mailing Address - Fax:
Practice Address - Street 1:146 MEDICAL PARK RD STE 108
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-8529
Practice Address - Country:US
Practice Address - Phone:704-660-4040
Practice Address - Fax:704-660-4884
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2025-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9700865208600000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8910672Medicaid
2240068AMedicare UPIN
NC8910672Medicaid
NC8910672Medicaid