Healthcare Provider Details

I. General information

NPI: 1083898555
Provider Name (Legal Business Name): SUZANNE ROSS SNYDER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SUZANNE LOUISE ROSS M.D.

II. Dates (important events)

Enumeration Date: 12/19/2007
Last Update Date: 07/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5525 E 82ND ST
INDIANAPOLIS IN
46250-1520
US

IV. Provider business mailing address

18887 AUBURN LN
NOBLESVILLE IN
46060-1590
US

V. Phone/Fax

Practice location:
  • Phone: 317-578-2700
  • Fax: 317-578-2827
Mailing address:
  • Phone: 317-523-5431
  • Fax: 317-578-2827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberH4713
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number1064581A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number32102
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: