Healthcare Provider Details

I. General information

NPI: 1548649627
Provider Name (Legal Business Name): BRIAN EDWARD SNYDER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2015
Last Update Date: 05/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 MEDICAL PARK, STE 350 EMERGENCY MEDICINE DEPARTMENT
COLUMBIA SC
29203
US

IV. Provider business mailing address

14 MEDICAL PARK, STE 350 EMERGENCY MEDICINE DEPARTMENT
COLUMBIA SC
29203
US

V. Phone/Fax

Practice location:
  • Phone: 803-434-3790
  • Fax: 803-434-3946
Mailing address:
  • Phone: 803-434-3790
  • Fax: 803-434-3946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number2018-00145
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberLL37625
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: