Provider Demographics
NPI:1699772103
Name:BAWTINHIMER, GARY G (MD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:G
Last Name:BAWTINHIMER
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 1:3675 ROUNTREE RD
Mailing Address - Street 2:
Mailing Address - City:AYDEN
Mailing Address - State:NC
Mailing Address - Zip Code:28513-8749
Mailing Address - Country:US
Mailing Address - Phone:252-414-9072
Mailing Address - Fax:
Practice Address - Street 1:3675 ROUNTREE RD
Practice Address - Street 2:
Practice Address - City:AYDEN
Practice Address - State:NC
Practice Address - Zip Code:28513-8749
Practice Address - Country:US
Practice Address - Phone:252-414-9072
Practice Address - Fax:252-439-0269
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC13941OtherBCBS NC
NC8913941Medicaid
NCC82746Medicare UPIN
NC204682FMedicare ID - Type Unspecified