Healthcare Provider Details

I. General information

NPI: 1801870753
Provider Name (Legal Business Name): SUSAN T SNIDER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2005
Last Update Date: 09/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 HOSPITAL DR
SPRUCE PINE NC
28777-8943
US

IV. Provider business mailing address

36 HOSPITAL DR
SPRUCE PINE NC
28777-8943
US

V. Phone/Fax

Practice location:
  • Phone: 828-765-6595
  • Fax: 828-765-6599
Mailing address:
  • Phone: 828-765-6595
  • Fax: 828-765-6599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number23763
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: