Healthcare Provider Details

I. General information

NPI: 1699867457
Provider Name (Legal Business Name): JOSEPH SNYDER PAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 12/03/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 SETON DR
CUMBERLAND MD
21502-1817
US

IV. Provider business mailing address

911 SETON DR
CUMBERLAND MD
21502-1817
US

V. Phone/Fax

Practice location:
  • Phone: 301-724-5885
  • Fax: 301-759-3332
Mailing address:
  • Phone: 301-724-5885
  • Fax: 301-759-3332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberC0003497
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: