Basic Information
| Provider Information | |||||||||
| NPI: | 1700847670 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SNOOK | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 5 NEPONSET ST FL STREET12 | ||||||||
| Address2: | |||||||||
| City: | WORCESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 016062714 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5085952655 | ||||||||
| FaxNumber: | 5084255220 | ||||||||
| Practice Location | |||||||||
| Address1: | 5 NEPONSET ST | ||||||||
| Address2: | |||||||||
| City: | WORCESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 016062714 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5085952655 | ||||||||
| FaxNumber: | 5084255220 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/30/2006 | ||||||||
| LastUpdateDate: | 09/26/2018 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | 74595 | MA | Y | Allopathic & Osteopathic Physicians | Dermatology |
ID Information
| ID | Type | State | Issuer | Description | 784086 | 01 | MVP HEALTH CARE | OTHER | J12081 | 01 | BLUE CARE ELECT | OTHER | J12081 | 01 | BLUE SHIELD HMO BLUE | OTHER | J12081 | 01 | MEDICARE B | OTHER | 042472266 | 01 | HEALTHCARE VALUE MANAGEME | OTHER | 3100545 | 05 | MA | MEDICAID | 0300126 | 01 | EVERCARE | OTHER | 042472266 | 01 | ONE HEALTH PLAN | OTHER | 7852920 | 01 | CIGNA HEALTH PLAN | OTHER | J12081 | 01 | BLUE SHIELD INDEMNITY | OTHER | 042472266 | 01 | PRIVATE HEALTHCARE SYSTEM | OTHER | 1061446 | 01 | FIRST HEALTH | OTHER | 33316 | 01 | CHILDRENS MEDICAL SECURIT | OTHER | AA4386 | 01 | HARVARD PILGRIM HEALTHCAR | OTHER | 3100545 | 01 | MEDICAID WELFARE | OTHER | 33316 | 01 | HEALTHY START | OTHER | 5844188 | 01 | AETNA US HEALTHCARE | OTHER | 9900848 | 01 | FALLON COMMUNITY HEALTH P | OTHER |