Provider Demographics
NPI:1578723656
Name:SNOW, MERYL JONES (DO)
Entity Type:Individual
Prefix:
First Name:MERYL
Middle Name:JONES
Last Name:SNOW
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 E SECOND AVE
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28052-4358
Mailing Address - Country:US
Mailing Address - Phone:704-874-1904
Mailing Address - Fax:704-867-2134
Practice Address - Street 1:420 N SALISBURY ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:NC
Practice Address - Zip Code:27292-3548
Practice Address - Country:US
Practice Address - Phone:336-243-7475
Practice Address - Fax:336-249-6771
Is Sole Proprietor?:No
Enumeration Date:2008-06-12
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1543207Q00000X
NC2013-02401207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1578723656Medicaid
VAP00960352Medicare PIN
VAVV2553BMedicare PIN
VA1578723656Medicaid