Provider Demographics
NPI:1316149321
Name:KEVIN L. SNYDER MD PA
Entity type:Organization
Organization Name:KEVIN L. SNYDER MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:SNYDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-879-8111
Mailing Address - Street 1:754 N HICKORY AVE
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-3042
Mailing Address - Country:US
Mailing Address - Phone:410-879-8111
Mailing Address - Fax:410-836-0945
Practice Address - Street 1:754 N HICKORY AVE
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-3042
Practice Address - Country:US
Practice Address - Phone:410-879-8111
Practice Address - Fax:410-836-0945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-01
Last Update Date:2016-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD33642207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD8069Medicare ID - Type Unspecified
MDD74738Medicare UPIN