Provider Demographics
NPI:1033152103
Name:SNITZER, JACK L (DO)
Entity Type:Individual
Prefix:
First Name:JACK
Middle Name:L
Last Name:SNITZER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 S DIVISION ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-7232
Mailing Address - Country:US
Mailing Address - Phone:410-572-8848
Mailing Address - Fax:
Practice Address - Street 1:1415 S DIVISION ST
Practice Address - Street 2:SUITE A
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-7232
Practice Address - Country:US
Practice Address - Phone:410-572-8848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH44532207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD447331100Medicaid
MDF21053Medicare UPIN
MD394M548FMedicare PIN