Healthcare Provider Details

I. General information

NPI: 1457302853
Provider Name (Legal Business Name): KENNETH L SNYDER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 10/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 HOSPITAL CENTER COMMON
HILTON HEAD SC
29926-2727
US

IV. Provider business mailing address

15 HOSPITAL CENTER COMMON
HILTON HEAD SC
29926-2727
US

V. Phone/Fax

Practice location:
  • Phone: 843-682-2800
  • Fax: 843-682-2786
Mailing address:
  • Phone: 843-682-2800
  • Fax: 843-682-2786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number959
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: