Healthcare Provider Details

I. General information

NPI: 1558397315
Provider Name (Legal Business Name): TIMOTHY JOHN SNIEZEK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 09/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3683 CHOPTANK RD
PRESTON MD
21655-1220
US

IV. Provider business mailing address

PO BOX 331
PRESTON MD
21655-0331
US

V. Phone/Fax

Practice location:
  • Phone: 410-673-1690
  • Fax: 410-673-1692
Mailing address:
  • Phone: 410-673-1690
  • Fax: 410-673-1692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD0053253
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: