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General NPI Number Information
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NPI Number | 1932185626
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Entity Type | Individual
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Provider Name | BRYAN DREW BLITSTEIN MD
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Gender | Male
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Dates
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Enumeration Date | 12/15/2005
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Last Update Date | 11/04/2025
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Provider Practice Location Address
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Address Line | 146 MEDICAL PARK RD STE 108
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City | MOORESVILLE
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State | NC
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Zip | 28117-8529
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Country | US
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Telephone | 704-660-4040
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Fax | 704-660-4884
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Provider Business Mailing Address
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Address Line | PO BOX 110566
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City | DURHAM
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State | NC
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Zip | 27709-5566
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Country | US
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Telephone | 919-620-4555
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 9700865
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License Number State | NC
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