Provider Demographics
NPI:1316948110
Name:SNYDER, NORMAN (MD)
Entity type:Individual
Prefix:
First Name:NORMAN
Middle Name:
Last Name:SNYDER
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 1:2020 IOWA AVE
Mailing Address - Street 2:HA103
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-2417
Mailing Address - Country:US
Mailing Address - Phone:951-781-2270
Mailing Address - Fax:951-787-6628
Practice Address - Street 1:4000 14TH ST
Practice Address - Street 2:STE 109
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-4083
Practice Address - Country:US
Practice Address - Phone:951-276-7500
Practice Address - Fax:951-276-7522
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA229212085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A229210Medicaid
CA00A229210Medicaid