Provider Demographics
NPI:1659689826
Name:SNELL, PHILLIP NELSON (IDMT)
Entity Type:Individual
Prefix:MR
First Name:PHILLIP
Middle Name:NELSON
Last Name:SNELL
Suffix:
Gender:M
Credentials:IDMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1192 WYNCOOP CREEK RD
Mailing Address - Street 2:
Mailing Address - City:CHEMUNG
Mailing Address - State:NY
Mailing Address - Zip Code:14825-9711
Mailing Address - Country:US
Mailing Address - Phone:607-529-8885
Mailing Address - Fax:
Practice Address - Street 1:1192 WYNCOOP CREEK RD
Practice Address - Street 2:
Practice Address - City:CHEMUNG
Practice Address - State:NY
Practice Address - Zip Code:14825-9711
Practice Address - Country:US
Practice Address - Phone:607-529-8885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-21
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians