Provider Demographics
NPI:1639401805
Name:JERRY ALLISON SNOW MD PC
Entity Type:Organization
Organization Name:JERRY ALLISON SNOW MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:ALLISON
Authorized Official - Last Name:SNOW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:202-262-6060
Mailing Address - Street 1:4900 MASSACHUSETTS AVE NW
Mailing Address - Street 2:SUITE 300
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20016-4358
Mailing Address - Country:US
Mailing Address - Phone:202-262-6060
Mailing Address - Fax:202-364-6555
Practice Address - Street 1:4900 MASSACHUSETTS AVE NW
Practice Address - Street 2:SUITE 300
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-4358
Practice Address - Country:US
Practice Address - Phone:202-262-6060
Practice Address - Fax:202-364-6555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-12
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCC62517Medicare UPIN