Healthcare Provider Details

I. General information

NPI: 1982652749
Provider Name (Legal Business Name): ELIZABETH A SNODERLY D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 06/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1204 E CHEVES ST
FLORENCE SC
29506-2710
US

IV. Provider business mailing address

PO BOX 1018
PAWLEYS ISLAND SC
29585-1018
US

V. Phone/Fax

Practice location:
  • Phone: 843-673-0122
  • Fax: 843-673-0127
Mailing address:
  • Phone: 843-651-2624
  • Fax: 843-357-4940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number0498
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number00498
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: