Provider Demographics
NPI:1831150143
Name:SNIPES, EDWARD R (MD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:R
Last Name:SNIPES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:735 FITZWATERTOWN RD
Mailing Address - Street 2:
Mailing Address - City:WILLOW GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19090-1332
Mailing Address - Country:US
Mailing Address - Phone:215-657-2012
Mailing Address - Fax:215-657-2018
Practice Address - Street 1:735 FITZWATERTOWN RD
Practice Address - Street 2:
Practice Address - City:WILLOW GROVE
Practice Address - State:PA
Practice Address - Zip Code:19090-1332
Practice Address - Country:US
Practice Address - Phone:215-657-2012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD034329E207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011828570004Medicaid
0118285703OtherAMERICHOICE OF PA
PA0260419000OtherKEYSTONE
1029489OtherKEYSTONE MERCY
PA0260419000OtherPERSONAL CHOICE
PA0260419000OtherAMERIHEALTH
PA1078273OtherCIGNA
4089602OtherAETNA
02334MD034329EOtherHEALTH PARTNERS
390001335OtherRAILROAD MEDICARE
448051OtherHIGHMARK BLUE SHIELD
4089602OtherAETNA
PA0011828570004Medicaid
390001335OtherRAILROAD MEDICARE