Provider Demographics
NPI:1407882228
Name:SNYDER, BENEDICT STEWART III (MD)
Entity Type:Individual
Prefix:DR
First Name:BENEDICT
Middle Name:STEWART
Last Name:SNYDER
Suffix:III
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:PO BOX 128
Mailing Address - Street 2:
Mailing Address - City:MONCURE
Mailing Address - State:NC
Mailing Address - Zip Code:27559-0128
Mailing Address - Country:US
Mailing Address - Phone:919-488-3400
Mailing Address - Fax:919-882-1008
Practice Address - Street 1:468 DOE RUN DR
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330-7994
Practice Address - Country:US
Practice Address - Phone:919-488-3400
Practice Address - Fax:919-882-1008
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2008-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC33147208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8913246Medicaid
NC213314DMedicare ID - Type Unspecified
NCA26601Medicare UPIN