Provider Demographics
NPI:1659327807
Name:SNYDER, JERROLD M (DO)
Entity Type:Individual
Prefix:DR
First Name:JERROLD
Middle Name:M
Last Name:SNYDER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1203 LANGHORNE NEWTOWN RD
Mailing Address - Street 2:#225, ST CLARE BLDG
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-1209
Mailing Address - Country:US
Mailing Address - Phone:215-750-7771
Mailing Address - Fax:215-750-6935
Practice Address - Street 1:540 WOODBOURNE RD
Practice Address - Street 2:
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-1835
Practice Address - Country:US
Practice Address - Phone:215-750-7771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS004264L207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1023906050002Medicaid
PAC31532Medicare UPIN
PA140480Medicare ID - Type Unspecified