Provider Demographics
NPI:1619605755
Name:SNYDER, MARK P
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:P
Last Name:SNYDER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3017 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:OH
Mailing Address - Zip Code:43078-9331
Mailing Address - Country:US
Mailing Address - Phone:937-631-2997
Mailing Address - Fax:
Practice Address - Street 1:3017 RIVER RD
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:OH
Practice Address - Zip Code:43078-9331
Practice Address - Country:US
Practice Address - Phone:937-631-2997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-08
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker