Healthcare Provider Details

I. General information

NPI: 1790989689
Provider Name (Legal Business Name): TRACY L SNYDER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 02/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2350 FREEDOM WAY STE 202
YORK PA
17402-8202
US

IV. Provider business mailing address

3421 CONCORD RD
YORK PA
17402-9001
US

V. Phone/Fax

Practice location:
  • Phone: 717-851-2465
  • Fax: 717-741-3043
Mailing address:
  • Phone: 717-851-1405
  • Fax: 717-851-6969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberOA000871
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: