Basic Information
| Provider Information | |||||||||
| NPI: | 1952387714 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ADAMS | ||||||||
| FirstName: | GLENN | ||||||||
| MiddleName: | BRUCE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 47 CHURCH ST | ||||||||
| Address2: | |||||||||
| City: | GROVETON | ||||||||
| State: | NH | ||||||||
| PostalCode: | 035824061 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6036361101 | ||||||||
| FaxNumber: | 6037885041 | ||||||||
| Practice Location | |||||||||
| Address1: | 47 CHURCH ST | ||||||||
| Address2: | |||||||||
| City: | GROVETON | ||||||||
| State: | NH | ||||||||
| PostalCode: | 035824061 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6036361101 | ||||||||
| FaxNumber: | 6037885041 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/22/2005 | ||||||||
| LastUpdateDate: | 05/19/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 11297 | NH | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | AA18369 | 01 | HARVARD PILGRIM HEALTH CA | OTHER | 1008094 | 05 | VT | MEDICAID | 3072003 | 05 | NH | MEDICAID |