Provider Demographics
NPI:1235426685
Name:SNIDER, ALICIA ELIZABETH (MD)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:ELIZABETH
Last Name:SNIDER
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 1:9500 MENTOR AVENUE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060
Mailing Address - Country:US
Mailing Address - Phone:440-354-0377
Mailing Address - Fax:440-354-9368
Practice Address - Street 1:9500 MENTOR AVENUE
Practice Address - Street 2:SUITE 200
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060
Practice Address - Country:US
Practice Address - Phone:440-354-0377
Practice Address - Fax:440-354-9368
Is Sole Proprietor?:No
Enumeration Date:2011-07-06
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL33908208600000X
OH35.140685208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0421934Medicaid