Provider Demographics
NPI:1285189381
Name:SNIDER, ETHAN (PA-C)
Entity Type:Individual
Prefix:
First Name:ETHAN
Middle Name:
Last Name:SNIDER
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 1:4801 HOWARD AVE
Mailing Address - Street 2:
Mailing Address - City:BELTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20705-1950
Mailing Address - Country:US
Mailing Address - Phone:301-312-2792
Mailing Address - Fax:
Practice Address - Street 1:180 MAPLE AVE W
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-5727
Practice Address - Country:US
Practice Address - Phone:571-363-3539
Practice Address - Fax:571-363-3540
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-18
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110007078363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant