DR. BRUCE EDGAR WALTHER MD
Complete NPI Record 1104060995
Family Medicine in York, PA

Active since April 24, 2009PECOS EnrolledAccepts Medicare Assignment

1401 ROOSEVELT AVE, YORK, PA 17404(717) 356-6250 Get Directions

NPPES record last updated: May 8, 2026. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: May 8, 2026, Mar 21, 2018 (2 updates tracked since 2018).

Complete NPI Dataset

This page contains the complete raw NPPES record for Dr. Bruce Edgar Walther, MD (NPI 1104060995), an individual family medicine provider in York, PA. All 60 fields on file are listed with their current values and official NPPES definitions, exactly as recorded in the National Plan and Provider Enumeration System. Only fields that contain data are included, so the number of fields shown varies from one NPI record to another.

Use the tools below to filter fields by category, search within the record, or jump straight to a specific field. You can download the full record as a CSV, JSON, Markdown or text file, or filter first and export only the fields you need. The Print Clean Summary button produces a printer-friendly copy of the record.

Search NPI Record

NPI Record Category

Jump to NPI Field

Registry File Document Utilities

NPI: 1104060995: The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
Entity Type Code: 1: Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Provider Last Name Legal Name: WALTHER: The last name of the provider. If the provider is an individual, this is the legal name.
Provider First Name: BRUCE: The first name of the provider, if the provider is an individual.
Provider Middle Name: EDGAR: The middle name of the provider, if the provider is an individual.
Provider Name Prefix Text: DR.: The name prefix or salutation of the provider if the provider is an individual; for example, Mr., Mrs., or Corporal.
Provider Credential Text: MD: The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.
Provider First Line Business Mailing Address: 601 MEMORY LN: The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".
Provider Business Mailing Address City Name: YORK: The city name in the mailing address of the provider being identified.
Provider Business Mailing Address State Name: PA: The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address State name".
Provider Business Mailing Address Postal Code: 174022231: The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".
Provider Business Mailing Address Country Code If outside U S : US: The country code in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address country code".
Provider Business Mailing Address Telephone Number: 7178511405: The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as "Provider location address telephone number".
Provider Business Mailing Address Fax Number: 7178516969: The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as "Provider location address fax number".
Provider First Line Business Practice Location Address: 1401 ROOSEVELT AVE: The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City Name: YORK: The city name in the location address of the provider being identified.
Provider Business Practice Location Address State Name: PA: The State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code: 174042244: The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code If outside U S : US: The country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number: 7173566250: The telephone number associated with the location address of the provider being identified.
Provider Enumeration Date: 4/24/2009: The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date: 5/8/2026: The date that a record was last updated or changed.
Provider Gender Code: M: The code designating the provider's gender if the provider is a person.
Healthcare Provider Taxonomy Code 1: 207Q00000X: This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
Provider License Number 1: MD047796L: The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with "provider taxonomy code".
Provider License Number State Code 1: PA: The two-letter state code representing the U.S. state or territory that issued the provider's license. This field is linked to the Provider License Number field and identifies the jurisdiction where that license is valid. A provider may have multiple state codes if they hold licenses in more than one state.
Healthcare Provider Primary Taxonomy Switch 1: Y: This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
Other Provider Identifier 1: 547259: An additional identifier number for the provider, either current or previously used. This may include IDs issued by health plans, state agencies, or other organizations. The value is collected from the NPI application or update form.
Other Provider Identifier Type Code 1: 01: A code that specifies the type of additional identifier associated with the provider, either current or past. Examples include UPIN (Universal Provider Identification Number), NSC (National Supplier Clearinghouse), OSCAR (CMS Certification Number), DEA (Drug Enforcement Administration number), state Medicaid ID, or a plan-specific PIN. The value is collected from the NPI application or update form.
Other Provider Identifier State 1: MD: The two-letter state code representing the U.S. state or territory that issued the additional provider identifier. This links the Other Provider Identifier to the state where it is valid or was assigned.
Other Provider Identifier Issuer 1: CAREFIRST MD BCBS: The name of the organization, agency, or health plan that assigned the additional provider identifier. This identifies who issued the number linked to Other Provider Identifier 1 (for example, a state Medicaid agency, Medicare, or a private insurance company).
Other Provider Identifier 2: 001664506: An additional identifier number for the provider, either current or previously used. This may include IDs issued by health plans, state agencies, or other organizations. The value is collected from the NPI application or update form.
Other Provider Identifier Type Code 2: 05: A code that specifies the type of additional identifier associated with the provider, either current or past. Examples include UPIN (Universal Provider Identification Number), NSC (National Supplier Clearinghouse), OSCAR (CMS Certification Number), DEA (Drug Enforcement Administration number), state Medicaid ID, or a plan-specific PIN. The value is collected from the NPI application or update form.
Other Provider Identifier State 2: PA: The two-letter state code representing the U.S. state or territory that issued the additional provider identifier. This links the Other Provider Identifier to the state where it is valid or was assigned.
Other Provider Identifier 3: 116580: An additional identifier number for the provider, either current or previously used. This may include IDs issued by health plans, state agencies, or other organizations. The value is collected from the NPI application or update form.
Other Provider Identifier Type Code 3: 01: A code that specifies the type of additional identifier associated with the provider, either current or past. Examples include UPIN (Universal Provider Identification Number), NSC (National Supplier Clearinghouse), OSCAR (CMS Certification Number), DEA (Drug Enforcement Administration number), state Medicaid ID, or a plan-specific PIN. The value is collected from the NPI application or update form.
Other Provider Identifier State 3: PA: The two-letter state code representing the U.S. state or territory that issued the additional provider identifier. This links the Other Provider Identifier to the state where it is valid or was assigned.
Other Provider Identifier Issuer 3: HIGHMARK BLUE SHIELD: The name of the organization, agency, or health plan that assigned the additional provider identifier. This identifies who issued the number linked to Other Provider Identifier 1 (for example, a state Medicaid agency, Medicare, or a private insurance company).
Other Provider Identifier 4: 3012398 (RDYCARE): An additional identifier number for the provider, either current or previously used. This may include IDs issued by health plans, state agencies, or other organizations. The value is collected from the NPI application or update form.
Other Provider Identifier Type Code 4: 01: A code that specifies the type of additional identifier associated with the provider, either current or past. Examples include UPIN (Universal Provider Identification Number), NSC (National Supplier Clearinghouse), OSCAR (CMS Certification Number), DEA (Drug Enforcement Administration number), state Medicaid ID, or a plan-specific PIN. The value is collected from the NPI application or update form.
Other Provider Identifier State 4: PA: The two-letter state code representing the U.S. state or territory that issued the additional provider identifier. This links the Other Provider Identifier to the state where it is valid or was assigned.
Other Provider Identifier Issuer 4: AMERIHEALTH MERCY - WMG: The name of the organization, agency, or health plan that assigned the additional provider identifier. This identifies who issued the number linked to Other Provider Identifier 1 (for example, a state Medicaid agency, Medicare, or a private insurance company).
Other Provider Identifier 5: 30123182 (CAREEXP.): An additional identifier number for the provider, either current or previously used. This may include IDs issued by health plans, state agencies, or other organizations. The value is collected from the NPI application or update form.
Other Provider Identifier Type Code 5: 01: A code that specifies the type of additional identifier associated with the provider, either current or past. Examples include UPIN (Universal Provider Identification Number), NSC (National Supplier Clearinghouse), OSCAR (CMS Certification Number), DEA (Drug Enforcement Administration number), state Medicaid ID, or a plan-specific PIN. The value is collected from the NPI application or update form.
Other Provider Identifier State 5: PA: The two-letter state code representing the U.S. state or territory that issued the additional provider identifier. This links the Other Provider Identifier to the state where it is valid or was assigned.
Other Provider Identifier Issuer 5: AMERIHEALTH MERCY - WMG: The name of the organization, agency, or health plan that assigned the additional provider identifier. This identifies who issued the number linked to Other Provider Identifier 1 (for example, a state Medicaid agency, Medicare, or a private insurance company).
Other Provider Identifier 6: P003074: An additional identifier number for the provider, either current or previously used. This may include IDs issued by health plans, state agencies, or other organizations. The value is collected from the NPI application or update form.
Other Provider Identifier Type Code 6: 01: A code that specifies the type of additional identifier associated with the provider, either current or past. Examples include UPIN (Universal Provider Identification Number), NSC (National Supplier Clearinghouse), OSCAR (CMS Certification Number), DEA (Drug Enforcement Administration number), state Medicaid ID, or a plan-specific PIN. The value is collected from the NPI application or update form.
Other Provider Identifier State 6: PA: The two-letter state code representing the U.S. state or territory that issued the additional provider identifier. This links the Other Provider Identifier to the state where it is valid or was assigned.
Other Provider Identifier Issuer 6: GATEWAY-WMG: The name of the organization, agency, or health plan that assigned the additional provider identifier. This identifies who issued the number linked to Other Provider Identifier 1 (for example, a state Medicaid agency, Medicare, or a private insurance company).
Other Provider Identifier 7: 20089975: An additional identifier number for the provider, either current or previously used. This may include IDs issued by health plans, state agencies, or other organizations. The value is collected from the NPI application or update form.
Other Provider Identifier Type Code 7: 01: A code that specifies the type of additional identifier associated with the provider, either current or past. Examples include UPIN (Universal Provider Identification Number), NSC (National Supplier Clearinghouse), OSCAR (CMS Certification Number), DEA (Drug Enforcement Administration number), state Medicaid ID, or a plan-specific PIN. The value is collected from the NPI application or update form.
Other Provider Identifier State 7: PA: The two-letter state code representing the U.S. state or territory that issued the additional provider identifier. This links the Other Provider Identifier to the state where it is valid or was assigned.
Other Provider Identifier Issuer 7: AMERIHEALTH MERCY-WMG: The name of the organization, agency, or health plan that assigned the additional provider identifier. This identifies who issued the number linked to Other Provider Identifier 1 (for example, a state Medicaid agency, Medicare, or a private insurance company).
Other Provider Identifier 8: 283545: An additional identifier number for the provider, either current or previously used. This may include IDs issued by health plans, state agencies, or other organizations. The value is collected from the NPI application or update form.
Other Provider Identifier Type Code 8: 01: A code that specifies the type of additional identifier associated with the provider, either current or past. Examples include UPIN (Universal Provider Identification Number), NSC (National Supplier Clearinghouse), OSCAR (CMS Certification Number), DEA (Drug Enforcement Administration number), state Medicaid ID, or a plan-specific PIN. The value is collected from the NPI application or update form.
Other Provider Identifier State 8: PA: The two-letter state code representing the U.S. state or territory that issued the additional provider identifier. This links the Other Provider Identifier to the state where it is valid or was assigned.
Other Provider Identifier Issuer 8: UNISON-WMG: The name of the organization, agency, or health plan that assigned the additional provider identifier. This identifies who issued the number linked to Other Provider Identifier 1 (for example, a state Medicaid agency, Medicare, or a private insurance company).
Is Sole Proprietor: N: Indicates whether the provider is registered as a sole proprietor. This is a single-character code: "Y" means the provider operates as a sole proprietor, and "N" means they do not.
NPI Certification Date: 5/8/2026: The date on which the National Provider Identifier (NPI) was officially assigned and certified to the provider. This reflects when the provider's NPI record first became active in the NPPES system.

Secondary Practice Locations 42

The first line of the secondary practice location address of the provider being identified. For providers with more than one physical location, this is a secondary practice location address. This address cannot include a Post Office box.

100 Frederick St Ste 101

1/42

Hanover, PA 17331-3518 · Phone (717) 851-7050

2775 N George St

2/42

York, PA 17406-3020 · Phone (717) 812-7300

1010 Plymouth Rd

3/42

York, PA 17402-3864 · Phone (717) 851-1800

1227 Baltimore St

4/42

Hanover, PA 17331-4406 · Phone (717) 812-5190

2149 S Queen St

5/42

York, PA 17403-4845 · Phone (717) 356-4460

96 Sofia Dr Ste 208

6/42

Shrewsbury, PA 17361-5201 · Phone (717) 812-2400

2250 E Market St

7/42

York, PA 17402-2857 · Phone (717) 851-1566

455 S Washington St Ste 12

8/42

Gettysburg, PA 17325-2516 · Phone (717) 339-2875

4050 N George Street Ext

9/42

Manchester, PA 17345-9347 · Phone (717) 356-4370

100 Eisenhower Dr

10/42

Hanover, PA 17331-5241 · Phone (717) 646-4201

717 Town Center Dr

11/42

York, PA 17408-4824 · Phone (717) 356-4240

446 N Reading Rd

12/42

Ephrata, PA 17522-9802 · Phone (717) 738-5275

9 Nathan Ln

13/42

Annville, PA 17003-6500 · Phone (717) 639-3350

430 N Main St

14/42

Spring Grove, PA 17362-1123 · Phone (717) 851-6500

101 W Airport Rd

15/42

Lititz, PA 17543-9274 · Phone (717) 466-2445

13515 Wolfe Rd Ste C

16/42

New Freedom, PA 17349-9346 · Phone (717) 812-2501

10 Muddy Creek Forks Rd Ste 3

17/42

Brogue, PA 17309-9497 · Phone (717) 812-5020

370 Saint Charles Way

18/42

York, PA 17402-4647 · Phone (717) 741-8003

4222 Lincoln Hwy

19/42

York, PA 17406-8083 · Phone (717) 812-2050

2339 S George St

20/42

York, PA 17403-5009 · Phone (717) 812-3040

2050 S Queen St Ste 100

21/42

York, PA 17403-4829 · Phone (717) 812-4240

1790 Old Trail Rd

22/42

Etters, PA 17319-9652 · Phone (717) 938-6588

605 S George St Ste 200

23/42

York, PA 17401-3161 · Phone (717) 851-2334

25 Monument Rd Ste 140

24/42

York, PA 17403-5057 · Phone (717) 741-8003

55 N Main St

25/42

Jacobus, PA 17407-1248 · Phone (717) 428-1911

235 Rosedale Dr

26/42

Manchester, PA 17345-1022 · Phone (717) 812-5229

820 Chambersburg Rd

27/42

Gettysburg, PA 17325-3310 · Phone (717) 373-4410 · Fax (717) 337-0267

4020 Carlisle Rd

28/42

Dover, PA 17315-3508 · Phone (717) 851-6400

2350 Freedom Way Ste 150

29/42

York, PA 17402-8200 · Phone (717) 851-7315

3065 Windsor Rd

30/42

Red Lion, PA 17356-8533 · Phone (717) 851-1700

2003 E Market St

31/42

York, PA 17402-2841 · Phone (717) 812-4242

3193 Cape Horn Rd

32/42

Red Lion, PA 17356-8810 · Phone (717) 812-5888

300 W King St Ste C

33/42

Littlestown, PA 17340-1446 · Phone (717) 339-2390

40 V Twin Dr Ste 204

34/42

Gettysburg, PA 17325-7878 · Phone (717) 339-2424

423 S Washington St

35/42

Gettysburg, PA 17325-2526 · Phone (717) 339-3165

2060 Carlisle Rd

36/42

Aspers, PA 17304-9707 · Phone (717) 339-2585

4910 Fairfield Rd Ste A

37/42

Fairfield, PA 17320-9510 · Phone (717) 339-3175

1575 Bannister St Ste 1

38/42

York, PA 17404-4946 · Phone (717) 812-2000

54 S Forrest St

39/42

York, PA 17404-5550 · Phone (717) 792-1811 · Fax (717) 553-1279

755 S Pleasant Ave

40/42

Dallastown, PA 17313-9252 · Phone (717) 851-1300

105 4th St # 727

41/42

East Berlin, PA 17316-9638 · Phone (717) 812-4900

2900 Carlisle Pike

42/42

New Oxford, PA 17350-8426 · Phone (717) 812-2554

Other Provider Identifiers 8

Legacy and payer-issued identifiers reported to the NPPES registry for this provider.

547259 Other

1/8

State: MD · Issuer: Carefirst Md Bcbs
Other: An additional provider identifier that does not correspond to any of the other defined identifier type categories.

001664506 Medicaid

2/8

State: PA
Medicaid (State-specific): A provider identification number assigned by an individual state's Medicaid program, used for billing and enrollment within that state's Medicaid system.

116580 Other

3/8

State: PA · Issuer: Highmark Blue Shield
Other: An additional provider identifier that does not correspond to any of the other defined identifier type categories.

3012398 (RDYCARE) Other

4/8

State: PA · Issuer: Amerihealth Mercy - Wmg
Other: An additional provider identifier that does not correspond to any of the other defined identifier type categories.

30123182 (CAREEXP.) Other

5/8

State: PA · Issuer: Amerihealth Mercy - Wmg
Other: An additional provider identifier that does not correspond to any of the other defined identifier type categories.

P003074 Other

6/8

State: PA · Issuer: Gateway-wmg
Other: An additional provider identifier that does not correspond to any of the other defined identifier type categories.

20089975 Other

7/8

State: PA · Issuer: Amerihealth Mercy-wmg
Other: An additional provider identifier that does not correspond to any of the other defined identifier type categories.

283545 Other

8/8

State: PA · Issuer: Unison-wmg
Other: An additional provider identifier that does not correspond to any of the other defined identifier type categories.

No registry entries match your active lookup criteria.