Provider Demographics
NPI:1376552265
Name:SNYDER, PHILIP D (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:D
Last Name:SNYDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 781076
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48278-1076
Mailing Address - Country:US
Mailing Address - Phone:317-528-4800
Mailing Address - Fax:317-865-1479
Practice Address - Street 1:7825 MCFARLAND LN
Practice Address - Street 2:SUITE A
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-3628
Practice Address - Country:US
Practice Address - Phone:317-787-9471
Practice Address - Fax:317-788-4746
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2021-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01027173207Q00000X
IN01027173A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100062630AMedicaid
IND94569Medicare UPIN
IN591110TMedicare PIN