Provider Demographics
NPI:1689836090
Name:SNIDER, TRACIE CHRISTINE (DO)
Entity Type:Individual
Prefix:DR
First Name:TRACIE
Middle Name:CHRISTINE
Last Name:SNIDER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 819
Mailing Address - Street 2:BOX 4642
Mailing Address - City:FPO
Mailing Address - State:AE
Mailing Address - Zip Code:09645-0047
Mailing Address - Country:US
Mailing Address - Phone:602-774-4510
Mailing Address - Fax:
Practice Address - Street 1:PSC 819
Practice Address - Street 2:BOX 4642
Practice Address - City:FPO
Practice Address - State:AE
Practice Address - Zip Code:09645-0047
Practice Address - Country:US
Practice Address - Phone:602-774-4510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-26
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102202450207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology