Provider Demographics
NPI:1023129228
Name:SNYDER, RICHARD P (DO)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:P
Last Name:SNYDER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:263 POMFRET STREET
Mailing Address - Street 2:
Mailing Address - City:PUTNAM
Mailing Address - State:CT
Mailing Address - Zip Code:06260-1835
Mailing Address - Country:US
Mailing Address - Phone:860-928-2068
Mailing Address - Fax:860-963-3089
Practice Address - Street 1:263 POMFRET STREET
Practice Address - Street 2:
Practice Address - City:PUTNAM
Practice Address - State:CT
Practice Address - Zip Code:06260-1835
Practice Address - Country:US
Practice Address - Phone:860-928-2068
Practice Address - Fax:860-963-3089
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000136207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B38967Medicare UPIN