Provider Demographics
NPI:1881669174
Name:SNYDERS, GLENN C (MD)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:C
Last Name:SNYDERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1800 CAMELOT DR
Mailing Address - Street 2:STE 200
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-2440
Mailing Address - Country:US
Mailing Address - Phone:757-491-7337
Mailing Address - Fax:757-491-2233
Practice Address - Street 1:1800 CAMELOT DR
Practice Address - Street 2:STE 200
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-2440
Practice Address - Country:US
Practice Address - Phone:757-491-7337
Practice Address - Fax:757-491-2233
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101039454208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006720048Medicaid
VA006720048Medicaid