Healthcare Provider Details

I. General information

NPI: 1821085192
Provider Name (Legal Business Name): TODD C. SNYDER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 11/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4402 SHIPYARD BLVD
WILMINGTON NC
28403-6161
US

IV. Provider business mailing address

4402 SHIPYARD BLVD
WILMINGTON NC
28403-6161
US

V. Phone/Fax

Practice location:
  • Phone: 910-202-3363
  • Fax:
Mailing address:
  • Phone: 910-202-3363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number2012-01635
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number2005-00319
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: