Healthcare Provider Details

I. General information

NPI: 1952894503
Provider Name (Legal Business Name): JACKSON WILARD SNYDER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2018
Last Update Date: 06/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9443 TURNBERRY DR
POTOMAC MD
20854-5443
US

IV. Provider business mailing address

9443 TURNBERRY DR
POTOMAC MD
20854-5443
US

V. Phone/Fax

Practice location:
  • Phone: 301-298-1449
  • Fax:
Mailing address:
  • Phone: 301-298-1449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License NumberD66294
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: