Hofstrom, Glen Theodore

Hofstrom, Glen Theodore is an individual health care provider with primary practice located at 145 Shaffer St , South Williamsport PA 17702-6727. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Hofstrom, Glen Theodore can be contacted via phone (570) 326-2447.

Contact Information

Primary practice address
145 Shaffer St South Williamsport PA 17702-6727
Phone: (570) 326-2447
Fax: (570) 326-1247
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X MD019823E Pennsylvania

Profile Details

NPI number 1619939550
LBN Legal business name Hofstrom, Glen Theodore
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 5th, 2006
Last updated Oct 20th, 2011 - about 15 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1619939550 NPPES
Pennsylvania Other 544226 AETNA
Pennsylvania Other 001793 AETNA
Pennsylvania Other B34545 AETNA
Pennsylvania MEDICAID 0010813260001 AETNA
Pennsylvania Other 057619 AETNA
Pennsylvania Other 1553395 AETNA

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