Healthcare Provider Details

I. General information

NPI: 1417571209
Provider Name (Legal Business Name): COREY AARON SNYDER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2020
Last Update Date: 08/11/2025
Certification Date: 08/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1331 MINNICH RD
NEW HAVEN IN
46774-2051
US

IV. Provider business mailing address

11109 PARKVIEW PLAZA DR # 117
FORT WAYNE IN
46845-1701
US

V. Phone/Fax

Practice location:
  • Phone: 260-425-5000
  • Fax: 260-425-5048
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01088147A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: