Healthcare Provider Details

I. General information

NPI: 1265786339
Provider Name (Legal Business Name): ANDREW DAVID SNYDER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2012
Last Update Date: 11/15/2023
Certification Date: 12/17/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4601 IRONBOUND ROAD
WILLIAMSBURG VA
23188
US

IV. Provider business mailing address

205 N 2ND STREET #12021
RICHMOND VA
23241
US

V. Phone/Fax

Practice location:
  • Phone: 757-253-5161
  • Fax:
Mailing address:
  • Phone: 202-643-7209
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0101261904
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: