Provider Demographics
NPI:1205389418
Name:SNYDER, JACOB D (PA-C)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:D
Last Name:SNYDER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 ARCH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-3214
Mailing Address - Country:US
Mailing Address - Phone:814-333-7109
Mailing Address - Fax:814-333-7108
Practice Address - Street 1:321 ARCH STREET STE 101
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335
Practice Address - Country:US
Practice Address - Phone:814-333-7109
Practice Address - Fax:814-333-7108
Is Sole Proprietor?:No
Enumeration Date:2016-07-25
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA003831363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103204099Medicaid