Individual
GLENN BRUCE GRIMES VANDERVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
112 N 7TH ST, CHAMBERSBURG, PA 17201-1720
(717) 217-4300
(717) 217-4217
Mailing address
601 MEMORY LN, YORK, PA 17402-2231
(717) 851-1405
(717) 851-6969
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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