Provider Demographics
NPI:1154997518
Name:GLOVER, RAESHUN TREY (MD)
Entity type:Individual
Prefix:
First Name:RAESHUN
Middle Name:TREY
Last Name:GLOVER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1161 21ST AVE S
Mailing Address - Street 2:MCN CC3322
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37232
Mailing Address - Country:US
Mailing Address - Phone:615-343-4882
Mailing Address - Fax:
Practice Address - Street 1:1215 LEE ST # 800904
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22908-0011
Practice Address - Country:US
Practice Address - Phone:434-924-1946
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-27
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program