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:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 33369
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28233-3369
Mailing Address - Country:US
Mailing Address - Phone:704-364-8100
Mailing Address - Fax:704-365-2073
Practice Address - Street 1:10030 GILEAD RD
Practice Address - Street 2:STE 300
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-7545
Practice Address - Country:US
Practice Address - Phone:704-895-9390
Practice Address - Fax:704-464-5948
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC97-00865208600000X
NC9700865208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8910672Medicaid
2240068AMedicare UPIN
NC8910672Medicaid
NC8910672Medicaid