Healthcare Provider Details

I. General information

NPI: 1689391468
Provider Name (Legal Business Name): CATHERINE SNYDER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2022
Last Update Date: 10/24/2022
Certification Date: 10/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 S GREENE ST
BALTIMORE MD
21201-1544
US

IV. Provider business mailing address

616 ACADEMY AVE
OWINGS MILLS MD
21117-1351
US

V. Phone/Fax

Practice location:
  • Phone: 410-328-9595
  • Fax:
Mailing address:
  • Phone: 410-356-1249
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR131321
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: