Healthcare Provider Details

I. General information

NPI: 1326262031
Provider Name (Legal Business Name): IAN PHILLIP SNIDER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 03/05/2021
Certification Date: 03/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 W LOCKHART ST
SAYRE PA
18840-1618
US

IV. Provider business mailing address

1 GUTHRIE SQ
SAYRE PA
18840-1625
US

V. Phone/Fax

Practice location:
  • Phone: 570-887-3920
  • Fax: 570-887-3035
Mailing address:
  • Phone: 570-888-5858
  • Fax: 570-887-2490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberOS019945
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207QB0002X
TaxonomyObesity Medicine (Family Medicine) Physician
License NumberOS019945
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code2083B0002X
TaxonomyObesity Medicine (Preventive Medicine) Physician
License NumberOS019945
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: