Provider Demographics
NPI:1972633204
Name:SNEIDER, MARY CATHARINE (DO)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:CATHARINE
Last Name:SNEIDER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:MARY
Other - Middle Name:CATHARINE
Other - Last Name:LEDDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:6481 CARLISLE PIKE
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17050-2377
Mailing Address - Country:US
Mailing Address - Phone:717-516-6396
Mailing Address - Fax:717-620-8093
Practice Address - Street 1:6481 CARLISLE PIKE
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17050-2377
Practice Address - Country:US
Practice Address - Phone:717-516-6396
Practice Address - Fax:717-620-8093
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2020-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS014769207Q00000X
DEC2-0008220207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
164805WNUOtherMEDICARE PTAN
PA102373551-0002Medicaid
PA102373551-0001Medicaid
DE1972633204Medicaid
164805WNUOtherMEDICARE PTAN
DE081804Medicare Oscar/Certification