Provider Demographics
NPI:1952613168
Name:CARTER-SNELL, BRITTANY DAWN (DO)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:DAWN
Last Name:CARTER-SNELL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:BRITTANY
Other - Middle Name:D
Other - Last Name:CARTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:3152 WOODWARD AVE
Mailing Address - Street 2:4727 SAINT ANTOINE ST.; SUITE 211
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-2724
Mailing Address - Country:US
Mailing Address - Phone:313-833-5032
Mailing Address - Fax:313-833-7851
Practice Address - Street 1:72 ERSKINE STREET
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2702
Practice Address - Country:US
Practice Address - Phone:313-338-8007
Practice Address - Fax:313-833-7851
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-06
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101022641207N00000X
OH34-010420207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI10337001Medicare PIN