Healthcare Provider Details

I. General information

NPI: 1588872980
Provider Name (Legal Business Name): JOHN W. SNYDER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 08/12/2022
Certification Date: 08/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 JENNICK DR
COLONIAL HEIGHTS VA
23834-4905
US

IV. Provider business mailing address

PO BOX 91734
RICHMOND VA
23291-1734
US

V. Phone/Fax

Practice location:
  • Phone: 804-526-5888
  • Fax: 804-526-5401
Mailing address:
  • Phone: 804-358-6100
  • Fax: 804-342-7619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number0101245094
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: