Individual
GLENNA LEA GRIDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
555 CARTHAGE ST, SANFORD, NC 27330-4104
(919) 774-6518
(919) 774-1831
Mailing address
205 PAGE RD, PINEHURST, NC 28374-8798
(919) 774-6518
(919) 774-1831
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
2005 00569
NC
208000000X
Pediatrics Physician
Primary
2005 00569
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1396J
BC/BS NC
NC
05
—
5901059
—
NC
01
—
FH1100110
FIRSTCAROLINACARE
NC
01
—
P00869141
RAILROAD MEDICARE PTAN
—
Enumeration date
08/02/2005
Last updated
02/01/2016
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