Healthcare Provider Details

I. General information

NPI: 1679734743
Provider Name (Legal Business Name): CARLY MARIE SNYDER D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CARLY MARIE DRAHUS D.O.

II. Dates (important events)

Enumeration Date: 06/22/2008
Last Update Date: 06/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5501 OLD YORK RD KORMAN B-14
PHILADELPHIA PA
19141-3018
US

IV. Provider business mailing address

18167 US HIGHWAY 19 N STE 650
CLEARWATER FL
33764-6576
US

V. Phone/Fax

Practice location:
  • Phone: 215-456-6336
  • Fax:
Mailing address:
  • Phone: 800-507-8874
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberOT012741
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberOS11593
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: