Provider Demographics
NPI:1477538304
Name:SNYDER, KURT MATTHEW (MD)
Entity Type:Individual
Prefix:DR
First Name:KURT
Middle Name:MATTHEW
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:PO BOX 683
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04903-0683
Mailing Address - Country:US
Mailing Address - Phone:207-873-6034
Mailing Address - Fax:207-872-9136
Practice Address - Street 1:33 WHITING HILL RD
Practice Address - Street 2:SUITE 1
Practice Address - City:BREWER
Practice Address - State:ME
Practice Address - Zip Code:04412-1021
Practice Address - Country:US
Practice Address - Phone:207-873-6034
Practice Address - Fax:207-872-9136
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME0188482085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME002425101Medicare PIN