Healthcare Provider Details

I. General information

NPI: 1316963127
Provider Name (Legal Business Name): BRIAN DALE SNYDER MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 08/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 LONGWOOD AVE
BOSTON MA
02115-5724
US

IV. Provider business mailing address

300 LONGWOOD AVE HUNNEWELL BUILDING SECOND FLOOR
BOSTON MA
02115-5724
US

V. Phone/Fax

Practice location:
  • Phone: 617-355-6021
  • Fax: 617-730-0459
Mailing address:
  • Phone: 617-355-7409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number76200
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: