Provider Demographics
NPI:1487694204
Name:SNYDER, MARJORIE BLUE (MD)
Entity type:Individual
Prefix:
First Name:MARJORIE
Middle Name:BLUE
Last Name:SNYDER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:277 STATE ST STE 2A
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-5440
Mailing Address - Country:US
Mailing Address - Phone:207-944-9323
Mailing Address - Fax:207-835-4983
Practice Address - Street 1:277 STATE ST STE 2A
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-5440
Practice Address - Country:US
Practice Address - Phone:207-944-9323
Practice Address - Fax:207-835-4983
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME0142332084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEE56651Medicare UPIN
MEMM6736Medicare ID - Type Unspecified