Provider Demographics
NPI:1598746752
Name:SNYDER, ROGER OWEN (MD)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:OWEN
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 72098
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44192-0002
Mailing Address - Country:US
Mailing Address - Phone:419-289-0333
Mailing Address - Fax:419-281-7903
Practice Address - Street 1:1941 BANEY RD S
Practice Address - Street 2:ASHLAND FAMILY PRACTICE/SAMARITAN PROFESSIONAL CORP
Practice Address - City:ASHLAND
Practice Address - State:OH
Practice Address - Zip Code:44805-4502
Practice Address - Country:US
Practice Address - Phone:419-289-0333
Practice Address - Fax:419-281-7903
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH51146207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0567060Medicaid
OH0567060Medicaid
OHSN0587542Medicare PIN