Healthcare Provider Details

I. General information

NPI: 1831150143
Provider Name (Legal Business Name): EDWARD R SNIPES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 05/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

735 FITZWATERTOWN RD
WILLOW GROVE PA
19090-1332
US

IV. Provider business mailing address

735 FITZWATERTOWN RD
WILLOW GROVE PA
19090-1332
US

V. Phone/Fax

Practice location:
  • Phone: 215-657-2012
  • Fax:
Mailing address:
  • Phone: 215-657-2012
  • Fax: 215-657-2018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberMD034329E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: