Provider Demographics
NPI:1558397315
Name:SNIEZEK, TIMOTHY JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:JOHN
Last Name:SNIEZEK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 331
Mailing Address - Street 2:
Mailing Address - City:PRESTON
Mailing Address - State:MD
Mailing Address - Zip Code:21655-0331
Mailing Address - Country:US
Mailing Address - Phone:410-673-1690
Mailing Address - Fax:410-673-1692
Practice Address - Street 1:3683 CHOPTANK RD
Practice Address - Street 2:
Practice Address - City:PRESTON
Practice Address - State:MD
Practice Address - Zip Code:21655-1220
Practice Address - Country:US
Practice Address - Phone:410-673-1690
Practice Address - Fax:410-673-1692
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2013-09-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD0053253207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G74894Medicare UPIN