Healthcare Provider Details

I. General information

NPI: 1003222555
Provider Name (Legal Business Name): REGINA SNOW DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2014
Last Update Date: 08/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5800 RIDGE AVE
PHILADELPHIA PA
19128-1737
US

IV. Provider business mailing address

648 CHILDS AVE
DREXEL HILL PA
19026-3805
US

V. Phone/Fax

Practice location:
  • Phone: 215-487-4284
  • Fax:
Mailing address:
  • Phone: 484-521-0233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberSC006537
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: