Healthcare Provider Details

I. General information

NPI: 1477761682
Provider Name (Legal Business Name): DANIELLE AMY SNYDERMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 S BROAD ST
PHILADELPHIA PA
19147-1005
US

IV. Provider business mailing address

144 LEVERINGTON AVE
PHILADELPHIA PA
19127-2018
US

V. Phone/Fax

Practice location:
  • Phone: 215-546-0224
  • Fax:
Mailing address:
  • Phone: 215-509-6225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD428364
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: