Healthcare Provider Details

I. General information

NPI: 1609295021
Provider Name (Legal Business Name): ALLISON SNYDER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2014
Last Update Date: 02/04/2025
Certification Date: 02/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 CIVIC CENTER BOULEVARD 2ND FLOOR, SOUTH PAVILION
PHILADELPHIA PA
19104-5127
US

IV. Provider business mailing address

3400 SPRUCE ST 3 W GATES
PHILADELPHIA PA
19104
US

V. Phone/Fax

Practice location:
  • Phone: 215-662-3606
  • Fax:
Mailing address:
  • Phone: 215-662-3606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMD486539
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: