Provider Demographics
NPI:1417987991
Name:SNELLER, JONATHAN A (DO)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:A
Last Name:SNELLER
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 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-859-1123
Mailing Address - Fax:717-859-2898
Practice Address - Street 1:4131A OREGON PIKE
Practice Address - Street 2:
Practice Address - City:EPHRATA
Practice Address - State:PA
Practice Address - Zip Code:17522-9550
Practice Address - Country:US
Practice Address - Phone:717-859-1123
Practice Address - Fax:717-859-2898
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS008630L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP002401OtherGATEWAY
PAP00256445OtherRAILROAD MEDICARE
PA50051196OtherCAPITAL BLUE
PA0015335040006Medicaid
784458OtherHIGHMARK/FREEDOM BLUE
784458UFWMedicare ID - Type Unspecified
PAG09009Medicare UPIN