Healthcare Provider Details

I. General information

NPI: 1235186784
Provider Name (Legal Business Name): THOMAS SNYDER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 12/10/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6030 W HIGHWAY 74 STE A
INDIAN TRAIL NC
28079-3468
US

IV. Provider business mailing address

PO BOX 19305
CHARLOTTE NC
28219-9305
US

V. Phone/Fax

Practice location:
  • Phone: 704-246-2777
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number28454
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number200301294
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: