Healthcare Provider Details

I. General information

NPI: 1073010484
Provider Name (Legal Business Name): LAUREN ELIZABETH SNYDER DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2018
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2523 DELANEY AVE
WILMINGTON NC
28403-6003
US

IV. Provider business mailing address

PO BOX 936857
ATLANTA GA
31193-6857
US

V. Phone/Fax

Practice location:
  • Phone: 910-763-5522
  • Fax: 910-763-0413
Mailing address:
  • Phone: 910-763-5522
  • Fax: 910-763-0413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34.015911
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2024-02968
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: