Provider Demographics
NPI:1356456263
Name:SNOW, BRIAN EDWARD (PA)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:EDWARD
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 1:4 HAWTHORNE DR
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-6912
Mailing Address - Country:US
Mailing Address - Phone:603-472-8888
Mailing Address - Fax:603-472-9090
Practice Address - Street 1:4 HAWTHORNE DR
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-6912
Practice Address - Country:US
Practice Address - Phone:603-472-8888
Practice Address - Fax:603-472-9090
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0237363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
R90816Medicare UPIN
AP0689Medicare PIN