Provider Demographics
NPI:1639369655
Name:SNIDER, GORDON B (MD)
Entity Type:Individual
Prefix:DR
First Name:GORDON
Middle Name:B
Last Name:SNIDER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1153 E MAIN ST
Mailing Address - Street 2:PO BOX 2563
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-4056
Mailing Address - Country:US
Mailing Address - Phone:740-687-8990
Mailing Address - Fax:740-687-8230
Practice Address - Street 1:1550 SHERIDAN DR
Practice Address - Street 2:SUITE 203
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-1381
Practice Address - Country:US
Practice Address - Phone:740-687-8397
Practice Address - Fax:740-654-4103
Is Sole Proprietor?:No
Enumeration Date:2007-07-26
Last Update Date:2016-12-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH35019597207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0076179Medicaid
OH0076179Medicaid