Provider Demographics
NPI:1508153511
Name:SNOOK, ADAM DICKINSON
Entity Type:Individual
Prefix:MR
First Name:ADAM
Middle Name:DICKINSON
Last Name:SNOOK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 LAKESIDE DR
Mailing Address - Street 2:UNIT O
Mailing Address - City:LEDYARD
Mailing Address - State:CT
Mailing Address - Zip Code:06339-1422
Mailing Address - Country:US
Mailing Address - Phone:757-375-4182
Mailing Address - Fax:
Practice Address - Street 1:13 LAKESIDE DR
Practice Address - Street 2:UNIT O
Practice Address - City:LEDYARD
Practice Address - State:CT
Practice Address - Zip Code:06339-1422
Practice Address - Country:US
Practice Address - Phone:757-375-4182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-29
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman