Provider Demographics
NPI:1104060995
Name:WALTHER, BRUCE EDGAR (MD)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:EDGAR
Last Name:WALTHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 MEMORY LN
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-2231
Mailing Address - Country:US
Mailing Address - Phone:717-812-4900
Mailing Address - Fax:717-259-7262
Practice Address - Street 1:820 CHAMBERSBURG RD
Practice Address - Street 2:
Practice Address - City:GETTYSBURG
Practice Address - State:PA
Practice Address - Zip Code:17325-3310
Practice Address - Country:US
Practice Address - Phone:717-373-4410
Practice Address - Fax:717-337-0267
Is Sole Proprietor?:No
Enumeration Date:2009-04-24
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD047796L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA283545OtherUNISON-WMG
PA20089975OtherAMERIHEALTH MERCY-WMG
PAP003074OtherGATEWAY-WMG
PA30123182 (CAREEXP.)OtherAMERIHEALTH MERCY - WMG
PA3012398 (RDYCARE)OtherAMERIHEALTH MERCY - WMG
MD547259OtherCAREFIRST MD BCBS
PA001664506Medicaid
PA116580OtherHIGHMARK BLUE SHIELD
PA157724FLTMedicare PIN
PA116580OtherHIGHMARK BLUE SHIELD
MD547259OtherCAREFIRST MD BCBS