Healthcare Provider Details

I. General information

NPI: 1922335611
Provider Name (Legal Business Name): HILLARY D. SNYDER PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2009
Last Update Date: 04/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 N BROAD ST
PHILADELPHIA PA
19140-5103
US

IV. Provider business mailing address

2450 W HUNTING PARK AVE MEDICAL STAFF OFFICE/ENROLLMENT
PHILADELPHIA PA
19129-1302
US

V. Phone/Fax

Practice location:
  • Phone: 215-707-3326
  • Fax:
Mailing address:
  • Phone: 215-728-6900
  • Fax: 781-937-6442

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberOA002405
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA054210
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: