Provider Demographics
NPI:1588641328
Name:SNADY-MCCOY, LORY (MD)
Entity Type:Individual
Prefix:DR
First Name:LORY
Middle Name:
Last Name:SNADY-MCCOY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 E MANNING ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-5109
Mailing Address - Country:US
Mailing Address - Phone:401-272-2020
Mailing Address - Fax:401-421-5979
Practice Address - Street 1:150 E MANNING ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-5109
Practice Address - Country:US
Practice Address - Phone:401-272-2020
Practice Address - Fax:401-421-5979
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD07778207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI054470OtherTUFTS
RI153551OtherHARVARD
RI180036455OtherRAILROAD MEDICARE
RI4850083OtherCIGNA
RIJ04938OtherRI BLUE SHIELD
RI0800154OtherUNITED
RI5804476OtherAETNA
RI1620OtherNEIGHBORHOOD RI
RI9001520Medicaid
MA9782486Medicaid
RIJ04938OtherMASS BLUE SHIELD
MA0021248OtherNEIGHBORHOOD MA
RI7000878Medicaid
RI201432OtherBLUE CHIP
RI603940OtherTUFTS GROUP #
MAM17024OtherBCBS MASS GROUP #
RI007005638Medicare PIN
RIJ04938OtherMASS BLUE SHIELD
RI054470OtherTUFTS
RIA68146Medicare UPIN