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NPI Code Detail

MEDICARE: DR. ROBERT GLEN BASHUK M.D.

MEDICARE: DR. ROBERT GLEN BASHUK M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084N0400XNeurology Physician026451GA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1130014132OTHERGARAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1316940547
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ROBERT GLEN BASHUK M.D.
Provider Business Mailing Address
First Line : 2200 CENTURY PKWY NE STE 260
Second Line :
City : ATLANTA
State : GA
Zip : 30345-3103
Country : US
Telephone Number : 404-946-9327
Fax Number : 833-941-2436
Provider Business Practice Location Address
First Line : 2200 CENTURY PKWY NE
Second Line :
City : ATLANTA
State : GA
Zip : 30345-3154
Country : US
Telephone Number : 404-946-9327
Fax Number : 833-941-2436
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/23/2005
Last Update Date : 07/22/2025

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