Provider Demographics
NPI:1396734190
Name:GIEDRAITIS, ROBERT BASIL (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:BASIL
Last Name:GIEDRAITIS
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 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-316-3030
Mailing Address - Fax:704-316-3025
Practice Address - Street 1:7825 BALLANTYNE COMMONS PKWY STE 150
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-3175
Practice Address - Country:US
Practice Address - Phone:704-544-6920
Practice Address - Fax:704-316-3061
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC36351208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8935466Medicaid
SCN36351Medicaid
NC2191953KMedicare PIN
F66597Medicare UPIN
SCN36351Medicaid