Provider Demographics
NPI:1861687758
Name:CHRISTOPHER A. SNYDER DO PC
Entity Type:Organization
Organization Name:CHRISTOPHER A. SNYDER DO PC
Other - Org Name:DERMATOLOGY CENTERS OF NEPA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:A
Authorized Official - Last Name:SNYDER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:570-802-1012
Mailing Address - Street 1:1016 W FRONT ST
Mailing Address - Street 2:
Mailing Address - City:BERWICK
Mailing Address - State:PA
Mailing Address - Zip Code:18603-4525
Mailing Address - Country:US
Mailing Address - Phone:570-802-0102
Mailing Address - Fax:570-802-0104
Practice Address - Street 1:1016 W FRONT ST
Practice Address - Street 2:
Practice Address - City:BERWICK
Practice Address - State:PA
Practice Address - Zip Code:18603-4525
Practice Address - Country:US
Practice Address - Phone:570-802-0102
Practice Address - Fax:570-802-0104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-13
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0S009236L207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAG81160Medicare UPIN