Basic Information
| Provider Information | |||||||||
| NPI: | 1033152103 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SNITZER | ||||||||
| FirstName: | JACK | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1415 S DIVISION ST | ||||||||
| Address2: | SUITE A | ||||||||
| City: | SALISBURY | ||||||||
| State: | MD | ||||||||
| PostalCode: | 218047232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4105728848 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1415 S DIVISION ST | ||||||||
| Address2: | SUITE A | ||||||||
| City: | SALISBURY | ||||||||
| State: | MD | ||||||||
| PostalCode: | 218047232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4105728848 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2006 | ||||||||
| LastUpdateDate: | 04/24/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RE0101X | H44532 | MD | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
ID Information
| ID | Type | State | Issuer | Description | 447331100 | 05 | MD | MEDICAID |