Provider Demographics
NPI:1760459812
Name:SNYDER, JENNIFER L
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:SNYDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11851 DETROIT AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-3016
Mailing Address - Country:US
Mailing Address - Phone:216-529-7125
Mailing Address - Fax:216-529-7196
Practice Address - Street 1:11851 DETROIT AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-3016
Practice Address - Country:US
Practice Address - Phone:216-529-7125
Practice Address - Fax:216-529-7196
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35076133S207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2190598Medicaid
OH4234951Medicare PIN
H29241Medicare UPIN
OH4234952Medicare PIN
OH4038529Medicare PIN