Provider Demographics
NPI:1114358652
Name:SNOW, CHAD ALLEN (PA)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:ALLEN
Last Name:SNOW
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 19305
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28219-9305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:144 POOLE RD
Practice Address - Street 2:STE 102
Practice Address - City:LELAND
Practice Address - State:NC
Practice Address - Zip Code:28451-9504
Practice Address - Country:US
Practice Address - Phone:910-641-8650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-10
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-04507363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC2314PAMedicaid
NC1114358652Medicaid
NCNCG027HMedicare PIN
NCNCG027EMedicare PIN
NCNCG027GMedicare PIN
SC2314PAMedicaid
NCNCG027DMedicare PIN