Healthcare Provider Details

I. General information

NPI: 1003077157
Provider Name (Legal Business Name): MICHAEL ISAAC SNIDERMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2008
Last Update Date: 03/24/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 WEST MAIN STREET
NEWARK OH
43055-1822
US

IV. Provider business mailing address

1320 WEST MAIN STREET
NEWARK OH
43055-1822
US

V. Phone/Fax

Practice location:
  • Phone: 220-564-4218
  • Fax: 220-564-4217
Mailing address:
  • Phone: 220-564-4218
  • Fax: 220-564-4217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA120384
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number35097161
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberA120384
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number35.097161
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: