Healthcare Provider Details

I. General information

NPI: 1629036116
Provider Name (Legal Business Name): MARK SNOWISE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 09/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 STOCKBRIDGE RD
LEE MA
01238-9316
US

IV. Provider business mailing address

710 STOCKBRIDGE RD
LEE MA
01238-9316
US

V. Phone/Fax

Practice location:
  • Phone: 413-243-0122
  • Fax: 413-243-2251
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number205153
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: