Provider Demographics
NPI:1063495745
Name:SNOOK-TIDD, PAMELA HARTING (MD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:HARTING
Last Name:SNOOK-TIDD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2026 N EWING ST
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:IN
Mailing Address - Zip Code:47274-3480
Mailing Address - Country:US
Mailing Address - Phone:812-524-3333
Mailing Address - Fax:812-524-3334
Practice Address - Street 1:2026 N EWING ST STE 200
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:IN
Practice Address - Zip Code:47274-3480
Practice Address - Country:US
Practice Address - Phone:812-524-3333
Practice Address - Fax:812-524-3334
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-28
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01047138A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000092362OtherANTHEM
IN200117390AMedicaid
IN200117390Medicaid