Provider Demographics
NPI:1063434801
Name:SNOW, JOSEPH ROBERT (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:ROBERT
Last Name:SNOW
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 1:250 PLEASANT ST
Mailing Address - Street 2:SUITE 1350
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-7539
Mailing Address - Country:US
Mailing Address - Phone:603-230-1970
Mailing Address - Fax:603-230-1971
Practice Address - Street 1:250 PLEASANT ST
Practice Address - Street 2:SUITE 1350
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-7539
Practice Address - Country:US
Practice Address - Phone:603-230-1970
Practice Address - Fax:603-230-1971
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2015-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH7821208600000X, 2083P0011X
TXL4133208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH7821OtherLICENSE
NH7821OtherLICENSE
B75435Medicare UPIN
TXL4133OtherLICENSE
NH30002415Medicaid
NHRE0393Medicare ID - Type Unspecified