Provider Demographics
NPI:1083898555
Name:SNYDER, SUZANNE ROSS (MD)
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:ROSS
Last Name:SNYDER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:SUZANNE
Other - Middle Name:LOUISE
Other - Last Name:ROSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:18887 AUBURN LN
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46060-1590
Mailing Address - Country:US
Mailing Address - Phone:317-523-5431
Mailing Address - Fax:317-578-2827
Practice Address - Street 1:5525 E 82ND ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-1520
Practice Address - Country:US
Practice Address - Phone:317-578-2700
Practice Address - Fax:317-578-2827
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-19
Last Update Date:2017-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH4713207R00000X
IN1064581A207R00000X
TN32102208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200888970Medicaid
INM400067849Medicare PIN