Provider Demographics
NPI:1699779124
Name:GLOVER, RENEE (MD)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:GLOVER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2518 S CROATAN HWY STE B
Mailing Address - Street 2:
Mailing Address - City:NAGS HEAD
Mailing Address - State:NC
Mailing Address - Zip Code:27959-8994
Mailing Address - Country:US
Mailing Address - Phone:252-441-7546
Mailing Address - Fax:252-441-4151
Practice Address - Street 1:2518 S CROATAN HWY STE B
Practice Address - Street 2:
Practice Address - City:NAGS HEAD
Practice Address - State:NC
Practice Address - Zip Code:27959-8994
Practice Address - Country:US
Practice Address - Phone:252-441-7546
Practice Address - Fax:252-441-4151
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC34013174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8936026Medicaid
NC36026OtherBCBS
NC8936026Medicaid
NC36026OtherBCBS