Provider Demographics
NPI:1881648400
Name:SNIDER, DARLENE (DO)
Entity Type:Individual
Prefix:
First Name:DARLENE
Middle Name:
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:PO BOX 449
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-0449
Mailing Address - Country:US
Mailing Address - Phone:740-374-4500
Mailing Address - Fax:740-374-5887
Practice Address - Street 1:160 GROSS ST
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-2031
Practice Address - Country:US
Practice Address - Phone:740-568-5612
Practice Address - Fax:740-568-5668
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.003945207PS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PS0010XAllopathic & Osteopathic PhysiciansEmergency MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000539804OtherANTHEM
OH000000696935OtherANTHEM
OHP00703835OtherRRMCR
OH0609738Medicaid
WV3810005488Medicaid
OH000000539804OtherANTHEM
OH000000696935OtherANTHEM
OHC03001Medicare UPIN