Provider Demographics
NPI:1316944689
Name:GEWIRTZ, ROBERT J (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:GEWIRTZ
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 7527
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-0727
Mailing Address - Country:US
Mailing Address - Phone:614-268-9561
Mailing Address - Fax:614-268-7849
Practice Address - Street 1:1030 REFUGEE RD STE 280
Practice Address - Street 2:
Practice Address - City:PICKERINGTON
Practice Address - State:OH
Practice Address - Zip Code:43147-0019
Practice Address - Country:US
Practice Address - Phone:614-533-5500
Practice Address - Fax:614-533-0103
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.078086207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64320971Medicaid
OH9057268004OtherUNITED HEALTHCARE PIN
OH000000209165OtherANTHEM PIN
OH310874776026OtherCARESOURCE PIN
OH5192036OtherAETNA PIN
OH9057268004OtherCIGNA HEALTHCARE PIN
OH2191104Medicaid
OH4982480002Medicare NSC
OHGE4020331Medicare PIN
OH000000209165OtherANTHEM PIN
OH5192036OtherAETNA PIN
OHGE4020332Medicare PIN
OHGE4020333Medicare PIN
OHP140006820Medicare PIN