Provider Demographics
NPI:1376622142
Name:SNIDER, GEORGE E JR (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:E
Last Name:SNIDER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1188 PINEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505
Mailing Address - Country:US
Mailing Address - Phone:304-599-3959
Mailing Address - Fax:304-599-1719
Practice Address - Street 1:1188 PINEVIEW DR
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505
Practice Address - Country:US
Practice Address - Phone:304-599-3959
Practice Address - Fax:304-599-1719
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV10645207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0101442000Medicaid
WVSN0446912Medicare ID - Type Unspecified
C35162Medicare UPIN