Provider Demographics
NPI:1427091354
Name:SNYDER, MICHAEL A (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
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:PO BOX 414402
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-0001
Mailing Address - Country:US
Mailing Address - Phone:866-898-7138
Mailing Address - Fax:616-975-9824
Practice Address - Street 1:771 ALBANY ST
Practice Address - Street 2:DOWLING 1 SOUTH
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2525
Practice Address - Country:US
Practice Address - Phone:617-414-4930
Practice Address - Fax:617-414-7759
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA208641207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA077662OtherTUFTS
MA208641OtherTUFTS
MAAA101476OtherPILGRIM HEALTH
MA0114669Medicaid
MAJ24529OtherBCBS
MA0114669Medicaid
MA077662OtherTUFTS
MA930116777Medicare PIN
MAP00428479Medicare PIN
MAA3167002Medicare PIN