Provider Demographics
NPI:1861453136
Name:SNIDER, GLENN RUSSELL JR (MD)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:RUSSELL
Last Name:SNIDER
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:RR 2 BOX 80
Mailing Address - Street 2:LAKE FLOYD
Mailing Address - City:BRISTOL
Mailing Address - State:WV
Mailing Address - Zip Code:26332-9313
Mailing Address - Country:US
Mailing Address - Phone:304-623-3461
Mailing Address - Fax:304-626-7026
Practice Address - Street 1:1 MEDICAL CENTER DRIVE
Practice Address - Street 2:MAIL STOP 11
Practice Address - City:CLARKSBURG
Practice Address - State:WV
Practice Address - Zip Code:26301
Practice Address - Country:US
Practice Address - Phone:304-623-7606
Practice Address - Fax:304-626-7026
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
WV12747207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine