Provider Demographics
NPI:1639106115
Name:SNOWBALL, MARCIA LYNNE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARCIA
Middle Name:LYNNE
Last Name:SNOWBALL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:MARCIA
Other - Middle Name:LYNNE
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5978 BERMUDA LN
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34119-9597
Mailing Address - Country:US
Mailing Address - Phone:330-715-5245
Mailing Address - Fax:
Practice Address - Street 1:5978 BERMUDA LN
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34119-9597
Practice Address - Country:US
Practice Address - Phone:330-715-5245
Practice Address - Fax:239-658-3175
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME90315207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL272539800Medicaid
FLA06244Medicare UPIN
FL272539800Medicaid