Healthcare Provider Details

I. General information

NPI: 1932598414
Provider Name (Legal Business Name): ROBERT PAUL SNYDER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/21/2015
Last Update Date: 01/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 RUSTIC LODGE RD SUITE B
INDIANA PA
15701-3440
US

IV. Provider business mailing address

399 SPAULDING RD
PENN RUN PA
15765-8633
US

V. Phone/Fax

Practice location:
  • Phone: 724-463-3720
  • Fax: 724-463-6111
Mailing address:
  • Phone: 412-841-1994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOS009746L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: