Healthcare Provider Details

I. General information

NPI: 1104555069
Provider Name (Legal Business Name): AMANDA SNOW MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2022
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

147 PELHAM ST
METHUEN MA
01844-2060
US

IV. Provider business mailing address

34 HAVERHILL ST
LAWRENCE MA
01841-2884
US

V. Phone/Fax

Practice location:
  • Phone: 978-686-0090
  • Fax:
Mailing address:
  • Phone: 978-686-0090
  • Fax: 978-681-5963

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1026095
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: