Provider Demographics
NPI:1235186784
Name:SNYDER, THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:SNYDER
Suffix:
Gender:M
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:PO BOX 19305
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28219-9305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6030 W HIGHWAY 74
Practice Address - Street 2:STE A
Practice Address - City:INDIAN TRAIL
Practice Address - State:NC
Practice Address - Zip Code:28079-3468
Practice Address - Country:US
Practice Address - Phone:704-246-2777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC28454207P00000X
NC200301294207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5903517Medicaid
NC1235186784Medicaid
NC1417WOtherBCBS OF NC
SCN01295Medicaid
NCNC5894AMedicare UPIN
E30854Medicare UPIN
NC2054250IMedicare PIN
NC1235186784Medicaid
NC2054250NMedicare PIN
NCNC5894BMedicare PIN
NC2054250CMedicare PIN
SCN01295Medicaid
NC2054250MMedicare PIN
NC2054250PMedicare PIN
SCAA38397772Medicare PIN
NC2054250FMedicare PIN
NC2054250EMedicare PIN
NC1417WOtherBCBS OF NC
NC2054250DMedicare PIN
NC2054250HMedicare PIN
NC2054250KMedicare PIN
NC2054250LMedicare PIN
NC2054250RMedicare PIN