Basic Information
| Provider Information | |||||||||
| NPI: | 1457652943 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SNOW | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | JOHN | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 933 S TALBOT ST STE 4 | ||||||||
| Address2: | |||||||||
| City: | ST MICHAELS | ||||||||
| State: | MD | ||||||||
| PostalCode: | 216632605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 1074502004 | ||||||||
| FaxNumber: | 3390822818 | ||||||||
| Practice Location | |||||||||
| Address1: | 933 S. TALBOT ST | ||||||||
| Address2: | UNIT 4 | ||||||||
| City: | ST. MICHAELS | ||||||||
| State: | MD | ||||||||
| PostalCode: | 216632633 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4107450200 | ||||||||
| FaxNumber: | 8339082281 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/15/2010 | ||||||||
| LastUpdateDate: | 10/29/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/29/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 34-003742 | OH | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | H0038590 | MD | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.