Provider Demographics
NPI:1609833573
Name:SNOW, ROSS ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:ROSS
Middle Name:ANTHONY
Last Name:SNOW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 369
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16512-0369
Mailing Address - Country:US
Mailing Address - Phone:814-454-4530
Mailing Address - Fax:814-456-2375
Practice Address - Street 1:2625 PARADE ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16504-2809
Practice Address - Country:US
Practice Address - Phone:814-452-6383
Practice Address - Fax:814-452-1427
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD022981E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0008054120004Medicaid
PA0008054120004Medicaid
PA391865Medicare Oscar/Certification
PAD71223Medicare UPIN