Healthcare Provider Details

I. General information

NPI: 1073515649
Provider Name (Legal Business Name): DEBORAH ALICE SNYDERMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 09/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 SOUTH 17TH STREET SUITE 1801
PHILADELPHIA PA
19103-6218
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:
Mailing address:
  • Phone: 215-985-4820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD 039738 E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: