Healthcare Provider Details

I. General information

NPI: 1316501711
Provider Name (Legal Business Name): ROSE SNYDER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2019
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1365 BROADWAY
BANGOR ME
04401-2401
US

IV. Provider business mailing address

1365 BROADWAY
BANGOR ME
04401-2401
US

V. Phone/Fax

Practice location:
  • Phone: 207-942-6226
  • Fax: 207-992-2756
Mailing address:
  • Phone: 207-942-6226
  • Fax: 207-992-2756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA381
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: