Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | DS018221A | PA |
NPI | 1083743363 |
---|---|
Provider Name | Dr. Mark B Snyder |
First Address | Philadelphia, PA 19102-2944 |
Second Address | Philadelphia, PA 19102-2944 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/03/2007 |
Last Update Date | 08/07/2007 |