Healthcare Provider Details

I. General information

NPI: 1033152103
Provider Name (Legal Business Name): JACK L SNITZER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 04/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 S DIVISION ST SUITE A
SALISBURY MD
21804-7232
US

IV. Provider business mailing address

1415 S DIVISION ST SUITE A
SALISBURY MD
21804-7232
US

V. Phone/Fax

Practice location:
  • Phone: 410-572-8848
  • Fax:
Mailing address:
  • Phone: 410-572-8848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberH44532
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: