Provider Demographics
NPI:1326288549
Name:DEBORAH A. SNYDERMAN, M.D., LLC
Entity Type:Organization
Organization Name:DEBORAH A. SNYDERMAN, M.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:ALICE
Authorized Official - Last Name:SNYDERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-985-4820
Mailing Address - Street 1:255 S 17TH ST
Mailing Address - Street 2:SUITE 1801
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-6231
Mailing Address - Country:US
Mailing Address - Phone:215-985-4820
Mailing Address - Fax:206-888-6574
Practice Address - Street 1:255 S 17TH ST
Practice Address - Street 2:SUITE 1801
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-6231
Practice Address - Country:US
Practice Address - Phone:215-985-4820
Practice Address - Fax:206-888-6574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-27
Last Update Date:2009-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD039738E2084P0015X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0015XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychosomatic MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA674038Medicare PIN
PAE86906Medicare UPIN