Provider Demographics
NPI:1770828774
Name:SNOW, JOHN O'HARA (PA)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:O'HARA
Last Name:SNOW
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18706 WOODBURN RD
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20175-9030
Mailing Address - Country:US
Mailing Address - Phone:703-779-8557
Mailing Address - Fax:
Practice Address - Street 1:18706 WOODBURN RD
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20175-9030
Practice Address - Country:US
Practice Address - Phone:703-779-8557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-01
Last Update Date:2012-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110002965363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical