Provider Demographics
NPI:1376711382
Name:SNYDER, RICHARD GALE (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:GALE
Last Name:SNYDER
Suffix:
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 1:3816 HIGHWAY 17 S
Mailing Address - Street 2:
Mailing Address - City:NORTH MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29582-5069
Mailing Address - Country:US
Mailing Address - Phone:843-272-1411
Mailing Address - Fax:843-272-2130
Practice Address - Street 1:3816 HIGHWAY 17 S
Practice Address - Street 2:
Practice Address - City:NORTH MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29582-5069
Practice Address - Country:US
Practice Address - Phone:843-272-1411
Practice Address - Fax:843-272-2130
Is Sole Proprietor?:No
Enumeration Date:2008-02-12
Last Update Date:2008-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11701208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC117019Medicaid
SCD54469084Medicare PIN
SCD54467719Medicare PIN
SCD05446Medicare UPIN