Provider Demographics
NPI:1255511531
Name:SNOW, JONATHAN FITTS (PA-C)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:FITTS
Last Name:SNOW
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 PLEASANT ST
Mailing Address - Street 2:STE 204
Mailing Address - City:NEW LONDON
Mailing Address - State:NH
Mailing Address - Zip Code:03257-5881
Mailing Address - Country:US
Mailing Address - Phone:603-926-0088
Mailing Address - Fax:603-926-2853
Practice Address - Street 1:250 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-7539
Practice Address - Country:US
Practice Address - Phone:603-225-7000
Practice Address - Fax:603-230-7218
Is Sole Proprietor?:No
Enumeration Date:2007-11-05
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0703363A00000X
MAAP2435363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30337120Medicaid
NH000400501Medicare PIN