Provider Demographics
NPI:1114933249
Name:SNYDER, LENA MAE (MD)
Entity Type:Individual
Prefix:DR
First Name:LENA
Middle Name:MAE
Last Name:SNYDER
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 1:6767 OLD MADISON PIKE STE 690
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35806-2198
Mailing Address - Country:US
Mailing Address - Phone:800-955-1919
Mailing Address - Fax:270-442-6294
Practice Address - Street 1:6767 OLD MADISON PIKE STE 690
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35806-2198
Practice Address - Country:US
Practice Address - Phone:800-955-1919
Practice Address - Fax:270-442-6294
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA145820208000000X
KY36292208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64035041Medicaid
K05143Medicare UPIN
KY0218Medicare UPIN
KY00931Medicare UPIN