Healthcare Provider Details

I. General information

NPI: 1093907404
Provider Name (Legal Business Name): JACK L SNITZER, D.O., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2007
Last Update Date: 08/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 S DIVISION ST STE A
SALISBURY MD
21804-7291
US

IV. Provider business mailing address

1415 S DIVISION ST STE A
SALISBURY MD
21804-7291
US

V. Phone/Fax

Practice location:
  • Phone: 410-572-8848
  • Fax: 410-572-6890
Mailing address:
  • Phone: 410-572-8848
  • Fax: 410-572-6890

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: JACK L SNITZER
Title or Position: OWNER
Credential: D.O.
Phone: 410-572-8848