Provider Demographics
NPI:1932277118
Name:BRAUTIGAN, ROBERT A (MD,)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:A
Last Name:BRAUTIGAN
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 1:5 FRANKLIN AVE
Mailing Address - Street 2:SUITE 406
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109-3532
Mailing Address - Country:US
Mailing Address - Phone:973-759-4499
Mailing Address - Fax:
Practice Address - Street 1:5 FRANKLIN AVE
Practice Address - Street 2:SUITE 406
Practice Address - City:BELLEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07109-3532
Practice Address - Country:US
Practice Address - Phone:973-759-4499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06991700208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8812608Medicaid
NJH57591Medicare UPIN
NJ056448DQ7Medicare ID - Type UnspecifiedINDIVIDUAL #