Healthcare Provider Details

I. General information

NPI: 1144412263
Provider Name (Legal Business Name): JUSTIN ARTHUR SNYDER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2007
Last Update Date: 03/19/2025
Certification Date: 03/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

735 NORMAN DR SUITE 3
LEBANON PA
17042-7497
US

IV. Provider business mailing address

PO BOX 300
LEBANON PA
17042-0300
US

V. Phone/Fax

Practice location:
  • Phone: 717-270-7908
  • Fax: 717-272-1734
Mailing address:
  • Phone: 717-270-7780
  • Fax: 717-274-9746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberOT011695
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number0S014229
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: