Healthcare Provider Details

I. General information

NPI: 1669481941
Provider Name (Legal Business Name): MICHELE VICKERS SNYDER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELE VICKERS

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 03/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 NEW BERN AVE NEONATOLOGY DEPT.
RALEIGH NC
27610-1231
US

IV. Provider business mailing address

3024 NEW BERN AVE SUITE 300
RALEIGH NC
27610-1247
US

V. Phone/Fax

Practice location:
  • Phone: 919-350-8545
  • Fax: 919-350-8146
Mailing address:
  • Phone: 919-350-8228
  • Fax: 919-350-7976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0096-01102
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number0096-01102
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: