Healthcare Provider Details

I. General information

NPI: 1962476986
Provider Name (Legal Business Name): REVA SNOW MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8401 CONNECTICUT AVE 201
CHEVY CHASE MD
20815
US

IV. Provider business mailing address

600 MCNEILL RD
SILVER SPRING MD
20910
US

V. Phone/Fax

Practice location:
  • Phone: 301-907-3960
  • Fax: 301-652-4933
Mailing address:
  • Phone: 301-530-5234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0061774
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: