MEDICARE: DR. GLENN C SNYDERS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	0101039454	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1881669174
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GLENN C SNYDERS MD

Provider Business Mailing Address
First Line	:	1800 CAMELOT DR
Second Line	:	STE 200
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-2440
Country	:	US
Telephone Number	:	757-491-7337
Fax Number	:	757-491-2233

Provider Business Practice Location Address
First Line	:	1800 CAMELOT DR
Second Line	:	STE 200
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-2440
Country	:	US
Telephone Number	:	757-491-7337
Fax Number	:	757-491-2233

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/21/2006
Last Update Date	:	09/30/2011

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