Basic Information
| Provider Information | |||||||||
| NPI: | 1447342183 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SNOW | ||||||||
| FirstName: | KEVIN | ||||||||
| MiddleName: | |||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 262 NEW LUDLOW RD | ||||||||
| Address2: | |||||||||
| City: | CHICOPEE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010204324 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4135354714 | ||||||||
| FaxNumber: | 4135354716 | ||||||||
| Practice Location | |||||||||
| Address1: | 575 BEECH ST | ||||||||
| Address2: | |||||||||
| City: | HOLYOKE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010402223 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4135342500 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2006 | ||||||||
| LastUpdateDate: | 09/01/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/01/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | 213952 | MA | N | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | 213952 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 110007116A | 05 | MA | MEDICAID |