Individual
DR. GLEN THEODORE HOFSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
145 SHAFFER ST, SOUTH WILLIAMSPORT, PA 17702-6727
(570) 326-2447
(570) 326-1247
Mailing address
1201 GRAMPIAN BLVD, SUITE 1K, WILLIAMSPORT, PA 17701-1900
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD019823E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0010813260001
—
PA
01
—
001793
FIRST PRIORITY HEALTH
PA
01
—
057619
HIGHMARK BLUE SHIELD
PA
01
—
1553395
UNITEDHEALTHCARE
PA
01
—
544226
AETNA
PA
01
—
B34545
HEALTHAMERICA
PA
Enumeration date
04/05/2006
Last updated
10/20/2011
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