Provider Demographics
NPI:1659548584
Name:SNIDER, ANDREW DAVID (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:DAVID
Last Name:SNIDER
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 1:1625 MAPLE LN
Mailing Address - Street 2:ESSENTIA HEALTH ASHLAND CLINIC
Mailing Address - City:ASHLAND
Mailing Address - State:WI
Mailing Address - Zip Code:54806-3768
Mailing Address - Country:US
Mailing Address - Phone:715-685-7500
Mailing Address - Fax:
Practice Address - Street 1:1625 MAPLE LN
Practice Address - Street 2:ESSENTIA HEALTH ASHLAND CLINIC
Practice Address - City:ASHLAND
Practice Address - State:WI
Practice Address - Zip Code:54806-3768
Practice Address - Country:US
Practice Address - Phone:715-685-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-09
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN52078207Q00000X
WI56716207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
01-37342OtherMEDICA
MN1659548584Medicaid
MN1659548584OtherBCBS
WI1659548584OtherGROUP HEALTH
P00767166OtherMEDICARE RAILROAD
MN080018682Medicare PIN