Provider Demographics
NPI:1013954643
Name:SNYDER DOUGHERTY, LORRAINE C (MD)
Entity Type:Individual
Prefix:
First Name:LORRAINE
Middle Name:C
Last Name:SNYDER DOUGHERTY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LORRAINE
Other - Middle Name:C
Other - Last Name:SNYDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:915 LAWN AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SELLERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18960-1551
Mailing Address - Country:US
Mailing Address - Phone:215-453-3300
Mailing Address - Fax:215-453-3306
Practice Address - Street 1:915 LAWN AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:SELLERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18960-1551
Practice Address - Country:US
Practice Address - Phone:215-453-3300
Practice Address - Fax:215-453-3306
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD417960207RH0003X
NJ25MA07409600207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1018498710001Medicaid
H76284Medicare UPIN
PA1018498710001Medicaid