Provider Demographics
NPI:1275976573
Name:SNYDER, MARY ANNE C (DO)
Entity Type:Individual
Prefix:DR
First Name:MARY ANNE
Middle Name:C
Last Name:SNYDER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:MARY ANNE
Other - Middle Name:C
Other - Last Name:ESTACIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1848 LAFAYETTE AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47201-5121
Mailing Address - Country:US
Mailing Address - Phone:812-748-3412
Mailing Address - Fax:812-748-3413
Practice Address - Street 1:806 JACKSON ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-6264
Practice Address - Country:US
Practice Address - Phone:812-748-3412
Practice Address - Fax:812-748-3413
Is Sole Proprietor?:No
Enumeration Date:2013-04-17
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ8644207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine