Healthcare Provider Details

I. General information

NPI: 1124463674
Provider Name (Legal Business Name): DUSTIN MICHAEL SNAPPER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2013
Last Update Date: 05/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3110 MACCORKLE AVE SE ROOM 3032
CHARLESTON WV
25304-1210
US

IV. Provider business mailing address

7904 IVYMOUNT TER
POTOMAC MD
20854-3732
US

V. Phone/Fax

Practice location:
  • Phone: 304-388-5590
  • Fax:
Mailing address:
  • Phone: 301-785-6039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: