Healthcare Provider Details

I. General information

NPI: 1750197166
Provider Name (Legal Business Name): MATTHEW SNODGRASS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2024
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 OSTRUM ST
BETHLEHEM PA
18015-1000
US

IV. Provider business mailing address

PO BOX 500
SOUDERTON PA
18964-0500
US

V. Phone/Fax

Practice location:
  • Phone: 315-323-5639
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN783086
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: