Provider Demographics
NPI:1073515649
Name:SNYDERMAN, DEBORAH ALICE (MD)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ALICE
Last Name:SNYDERMAN
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 1:255 S 17TH ST
Mailing Address - Street 2:SUITE 1801
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-6231
Mailing Address - Country:US
Mailing Address - Phone:215-985-4820
Mailing Address - Fax:
Practice Address - Street 1:255 SOUTH 17TH STREET
Practice Address - Street 2:SUITE 1801
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-6218
Practice Address - Country:US
Practice Address - Phone:215-985-4820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-12
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD 039738 E2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASN674038Medicare ID - Type Unspecified
PAE86906Medicare UPIN