Healthcare Provider Details

I. General information

NPI: 1255361333
Provider Name (Legal Business Name): PETER J SNYDER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 04/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 CIVIC CENTER BLVD WEST PAVILION, 4TH FLOOR
PHILADELPHIA PA
19104-5127
US

IV. Provider business mailing address

3400 CIVIC CENTER BLVD WEST PAVILION, 4TH FLOOR
PHILADELPHIA PA
19104-5127
US

V. Phone/Fax

Practice location:
  • Phone: 215-662-2300
  • Fax:
Mailing address:
  • Phone: 215-662-2300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberMD012727E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: