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Individual
GLENN BRUCE GRIMES VANDERVER
Active
Individual
GLENN BRUCE GRIMES VANDERVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
D0063178
MD
207R00000X
Internal Medicine Physician
MD447885
PA
2083P0901X
Public Health & General Preventive Medicine Physician
MD447885
PA
208M00000X
Hospitalist Physician
Primary
MD447885
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102820537
—
PA
05
—
3810005850
—
WV
05
—
415402900
—
MD
01
—
647682 01
CAREFIRST BC BS
MD
01
—
J697 0007
BLUE CHOICE
DC
01
—
KS04
MEDICARE
MD
01
—
P00337741
TRAVELERS MEDICARE
MD
Enumeration date
05/23/2006
Last updated
09/16/2024
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