Healthcare Provider Details

I. General information

NPI: 1326288549
Provider Name (Legal Business Name): DEBORAH A. SNYDERMAN, M.D., LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2009
Last Update Date: 02/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 S 17TH ST SUITE 1801
PHILADELPHIA PA
19103-6231
US

IV. Provider business mailing address

255 S 17TH ST SUITE 1801
PHILADELPHIA PA
19103-6231
US

V. Phone/Fax

Practice location:
  • Phone: 215-985-4820
  • Fax: 206-888-6574
Mailing address:
  • Phone: 215-985-4820
  • Fax: 206-888-6574

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License NumberMD039738E
License Number StatePA

VIII. Authorized Official

Name: DEBORAH ALICE SNYDERMAN
Title or Position: OWNER
Credential: M.D.
Phone: 215-985-4820