Provider Demographics
NPI:1003395930
Name:GLOVER, JOHN TERENCE
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:TERENCE
Last Name:GLOVER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 SQUAREVIEW LN
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-1866
Mailing Address - Country:US
Mailing Address - Phone:772-204-6934
Mailing Address - Fax:
Practice Address - Street 1:322 SQUAREVIEW LN
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-1866
Practice Address - Country:US
Practice Address - Phone:772-204-6934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-10
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)