Individual provider Active NPI

Robert Emmet Gallivan, MD

  • Family Medicine Physician
  • Durham, NC
National Provider Identifier
1962107755
Registry record updated Jun 29, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
2026-01440 Issued in NC
Practice address
3475 Erwin Rd
Durham, NC 27705-0005
Phone
(919) 613-7797
NPI assigned
Apr 3, 2023
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 29, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 2026-01440 NC Primary

Addresses

Primary practice location

3475 Erwin Rd
Durham, NC 27705-0005

Mailing address

3475 Erwin Rd
Durham, NC 27705-0005

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230927002393 NC Order and Referring Only - Family PracticePractitioner - Family Practice 7012361876

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1680480000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1782691200000",
    "number": "1962107755",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3475 ERWIN RD",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277050005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3475 ERWIN RD",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277050005",
            "telephone_number": "919-613-7797"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GALLIVAN",
        "first_name": "ROBERT",
        "middle_name": "EMMET",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-04-03",
        "last_updated": "2026-06-29",
        "certification_date": "2026-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "2026-01440",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Durham, NC

Sources for this page

Verify at the official NPI Registry.