Provider Demographics
NPI:1437135720
Name:SNIOCH, AGNIESZKA B (MD)
Entity Type:Individual
Prefix:
First Name:AGNIESZKA
Middle Name:B
Last Name:SNIOCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5 NEPONSET ST
Mailing Address - Street 2:WOT 2ND FL, STE C203
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01606-2714
Mailing Address - Country:US
Mailing Address - Phone:978-466-3208
Mailing Address - Fax:978-840-1680
Practice Address - Street 1:225 NEW LANCASTER RD
Practice Address - Street 2:
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-4958
Practice Address - Country:US
Practice Address - Phone:978-466-3208
Practice Address - Fax:978-840-1680
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2018-12-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA224420207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110041556AMedicaid
J29328OtherBLUE CARE ELECT
042472266OtherPRIVATE HEALTHCARE SYST.
494183OtherTUFTS HEALTH PLAN
A2621AOtherHARVARD PILGRIM HEALTH
A39089OtherMEDICARE B
04 2472266OtherTRICARE CHAMPOS
J29328OtherBLUE SHIELD ENDEMNITY
A39089OtherMEDICARE B
J29328OtherBLUE CARE ELECT