Provider Demographics
NPI:1033163605
Name:SNOWDEN OPALAK, LENORE M (MD)
Entity Type:Individual
Prefix:
First Name:LENORE
Middle Name:M
Last Name:SNOWDEN OPALAK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 CORPORATE DR
Mailing Address - Street 2:SUITE 394
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484-6211
Mailing Address - Country:US
Mailing Address - Phone:203-225-0375
Mailing Address - Fax:203-225-0376
Practice Address - Street 1:4 CORPORATE DR
Practice Address - Street 2:SUITE 394
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-6211
Practice Address - Country:US
Practice Address - Phone:203-225-0375
Practice Address - Fax:203-225-0376
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT027775207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001277755Medicaid
CTA52608Medicare UPIN
CT001277755Medicaid