Healthcare Provider Details

I. General information

NPI: 1750363578
Provider Name (Legal Business Name): JOHN A. SNYDER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2005
Last Update Date: 10/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2602 BUFORD RD
RICHMOND VA
23235-3422
US

IV. Provider business mailing address

PO BOX 13343
RICHMOND VA
23225-0343
US

V. Phone/Fax

Practice location:
  • Phone: 804-272-8806
  • Fax: 804-272-2909
Mailing address:
  • Phone: 804-272-8806
  • Fax: 804-272-2909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number200200807
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number0101054495
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: